Surgical Treatment of Post-Carotid Endarterectomy Carotid Pseudoaneurysm

Abstract

Post-endarterectomy pseudoaneurysms (PEPA) are a rare complication of carotid endarterectomy (CEA), but are associated with high morbidity risk. Therefore, once they are diagnosed, treatment is urgent to prevent possible complications such as rupture, embolisation, thrombosis, or airway and cranial nerve compression. In this video, the surgical procedure is shown in a case of PEPA 10 years after CEA with patch angioplasty, which was successfully managed by surgical excision and interposition of great saphenous vein graft. Follow up duplex examination at six months was normal, with patency of the vein graft. This case reiterates the importance of open surgery as the treatment of choice for this difficult clinical setting.

Adjunctive techniques in endovascular repair of postcarotid endarterectomy pseudoaneurysm: Case report and literature review

“…Repair of PA is usually required because of the risk for thrombosis, distal embolization, rupture, or more rarely, as in our case, to solve compression symptoms. Open surgical repair is technically demanding as it is performed on a hostile neck, and being associated with a significant risk of embolic events, cranial nerve injury (6%–44%), and mortality (6%) 1 . In the last decades, a less invasive endovascular approach has been increasingly used; it avoids a redo in a hostile surgical field, provides easier access to more proximal or distal lesions, and can be performed under local anesthesia.…”

“…PA after CEA is a rare complication occurring in less than 1% of cases 1–3 . Post‐CEA PA have been reported to be 2–4 times more common after patch angioplasty than after primary closure 2,5 .…”

“…Open surgical repair is technically demanding as it is performed on a hostile neck, and being associated with a significant risk of embolic events, cranial nerve injury (6%-44%), and mortality (6%). 1 In the last decades, a less invasive endovascular approach has been increasingly used; it avoids a redo in a hostile surgical field, provides easier access to more | 903 proximal or distal lesions, and can be performed under local anesthesia. In the literature review process, we found 29 papers for an overall amount of 39 patients with post-CEA PA treated by an endovascular approach since 2000 (Table 1).…”

“…Pseudoaneurysm (PA) following carotid endarterectomy (CEA) is a rare complication and occurs in about 0.3%-0.6% of cases. [1][2][3] The pathophysiology of PA may be due to suture line failure, degeneration of the arterial wall or patch, infection, clamp-induced damage, and shunt use. 4 Some authors report this rare complication to be twice as common after patch angioplasty compared with primary closure.…”

Acquired Carotid-Jugular Fistula Secondary to a Pseudoaneurysm Following Carotid Endarterectomy

“…[2][3][4] The natural history of pseudoaneurysms is poorly understoodthe pathology has been described days to years following a patient's CEA. 6 Acquired arteriovenous fistulas (AVFs) involving the carotid artery are most commonly the result of high-velocity penetrating trauma and stab wounds, or iatrogenic causes such as diagnostic and therapeutic catheterisation of the neck vessels. Infrequently, AVFs may develop spontaneously due to erosion of an aneurysm into an adjacent vein.…”