Carotid Pseudoaneurysm After Eversion Endarterectomy: A Case Report and Review of the Literature

Abstract

In our experience and with the evidence observed in the literature, open surgery with GSV interposition is the safest treatment in infected carotid PAs. The endovascular approach must be performed only in proven noninfectious cases. A bridge technique with the insertion of a stent followed by open surgery repair can be an option in emergency cases.

Surgical Treatment of Post-Carotid Endarterectomy Carotid Pseudoaneurysm

“…Other surgical options include reconstruction of the artery with a prosthetic graft or even by primary closure or patch angioplasty. 1,4 In conclusion, this case reiterates the importance of open surgery as the treatment of choice for this difficult clinical setting, notwithstanding the possibility of associated morbidity, even in experienced hands.…”

“…1 According to Seward et al, the peri-operative incidence of ischaemic events after an endovascular approach can be as high as 7%. 4,7 In this case, the pseudoaneurysm was resected and successfully replaced with a vein graft. Other surgical options include reconstruction of the artery with a prosthetic graft or even by primary closure or patch angioplasty.…”

“…Open surgery is currently the treatment of choice, regardless of it being technically more demanding in a previously operated neck and being associated with a significant risk of embolic events, cranial nerve injury (6e44% of the cases), and a 6% mortality rate. 1,3,4,6 On the other hand, and despite being increasingly used in this setting, endovascular treatments are also certainly not free of complications such as transient ischaemic attacks, stroke, and stent occlusion. 1 According to Seward et al, the peri-operative incidence of ischaemic events after an endovascular approach can be as high as 7%.…”

“…Additionally, some authors report this rare complication to be twice as common after patch angioplasty compared with primary closure. 1,3,4 This video shows the surgical procedure in a case of PEPA 10 years after CEA with patch closure, which was successfully managed by surgical excision and interposition of great saphenous vein graft.…”

Ruptured Internal Carotid Artery Pseudoaneurysm 10 Years after Cervical Spine Surgery

“…If untreated, a pseudoaneurysm can rupture, resulting in a life-threatening complication. Various etiologies include carotid endarterectomy [1], trauma, infection [2], arterial dissection, or iatrogenic causes such as venous catheterization. Vasculitis, neck surgery, transsphenoidal surgery [3], and neurofibromatosis type 1 [4] can cause the disease.…”