title: Treatment of a cervical carotid pseudoaneurysm that occurred years after laryngectomy and irradiation of a neck tumor.
abstract: A 62-year-old man presented with rupture of a pseudoaneurysm of the left common carotid artery (CCA) that was induced after radiation therapy and neck surgery. The initial treatment was an endovascular procedure to obliterate the aneurysm with coils, and a covered stent was placed in the parent artery. However, the patient presented with subsequent coil migration, wound infection, and left CCA stenosis. Direct surgical procedures were then performed, including resection of the pseudoaneurysm with coils and stent; replacement of the carotid artery with a saphenous vein graft; and operative wound reinforcement with a pedicle flap. Endovascular treatments may be chosen for vascular diseases after irradiation, because of the low risk of wound infection and fragility of the vessels, but the long-term outcomes of intravascular treatments are still unclear. In direct surgery, dissection of the adhesive tissue and adequate wound healing are difficult. Musculocutaneous flaps with vascular pedicles can achieve good results.
authors.affiliation: Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan. hanakita-s@umin.ac.jp
authors.forename: Shunya
authors.initials: S
authors.lastname: Hanakita
authors.forename: Akira
authors.initials: A
authors.lastname: Iijima
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
authors.forename: Kyousuke
authors.initials: K
authors.lastname: Kamada
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Saito
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002340:Carotid Artery Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D020212:Carotid Artery Injuries / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008223:Lymphoma / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D015607:Stents / Q000009:adverse effects