title: Internal carotid artery rupture caused by carotid shunt insertion.
abstract: BACKGROUND
  Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously.
  
  
  METHODS
  A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful.
  
  
  CONCLUSIONS
  Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect.
  
  
  CONCLUSIONS
  Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA.
authors.affiliation: The "Francesco Durante" Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy. Electronic address: giulio.illuminati@uniroma1.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Illuminati
authors.affiliation: The "Francesco Durante" Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
authors.forename: Francesco G
authors.initials: FG
authors.lastname: Caliò
authors.affiliation: The "Francesco Durante" Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pizzardi
authors.affiliation: The "Francesco Durante" Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vietri
keywords: Carotid endarterectomy; Carotid shunt; Shunt-related complications