title: Hybrid stent-graft repair of an iatrogenic complex proximal right common carotid artery injury.
abstract: BACKGROUND
  Iatrogenic carotid trauma requires early diagnosis and adequate treatment. Classic open repair may be technically challenging if trauma is in base of the neck. We present a case of an iatrogenic carotid pseudoaneurysm treated with endovascular repair.
  
  
  METHODS
  An 87-year-old woman presented with a pulsatile neck mass 10 days after coronary artery bypass graft surgery. A computed tomographic angiogram showed a 1.6 × 1.0 × 2.0-cm pseudoaneurysm arising from the posterior wall of the proximal right common carotid artery. Endovascular management was considered, and a percutaneous angiogram demonstrated an arteriovenous fistula in addition to the pseudoaneurysm. Through a cervical cut-down, retrograde percutaneous access was obtained through the common carotid artery, which allowed easier access to the area of trauma owing to vessel tortuosity. Subsequently, a 5 mm × 2-cm Viabahn was deployed. The postdilation angiogram showed a significant endoleak that kept filling the pseudoaneurysm. A second 6 mm × 5-cm Viabahn was placed and successfully postdilated with a 6 mm × 4-cm balloon. No endoleaks or fistulas were noted on the completion angiogram.
  
  
  RESULTS
  The patient remains asymptomatic after 15 months. Follow-up images showed thrombosis of pseudoaneurysm.
  
  
  CONCLUSIONS
  Endovascular treatment with self-expanding stent-grafts and open cut-down access are excellent options to treat major vessel injuries at the base of the neck, where anatomy and cumbersome access make open surgery a more difficult option.
authors.affiliation: Department of Vascular Surgery, Pontificia Universidad Catolica, Santiago, Chile. marinepolo@yahoo.com
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Marine
authors.forename: Timur P
authors.initials: TP
authors.lastname: Sarac
mesh_terms: D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000792:Angiography; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001807:Blood Vessel Prosthesis; D020212:Carotid Artery Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000601:surgery; D003937:Diagnosis, Differential; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D011474:Prosthesis Design; D015607:Stents