Traumatic Pseudoaneurysm of the Cervical Carotid Artery: The Value of Arteriography

Abstract

A patient who sustained a gunshot wound to the neck and subsequent blunt trauma is presented. No angiogram was performed after the initial injury. Subsequently, the patient developed a cerebral embolus from a thrombus dislodged from a pseudoaneurysm of the cervical carotid artery, resulting in complete occlusion of the distal internal carotid artery. After antiplatelet therapy, the distal internal carotid artery recanalized. and the pseudoaneurysm occluded spontaneously. We stress the need for the use of arteriography in the initial evaluation of penetrating injuries to the neck and the utility of repeated arteriograms for further treatment planning as these traumatic lesions can change with time.

Pseudoaneurysm of the proximal facial artery presenting as oropharyngeal hemorrhage

“…2,6,7,8,10 The initial injury to the affected artery may be undiagnosed at the time of initial trauma, despite surgical exploration or arteriography. 8,19,20 Even more rare are PAs of deeper vessels, such as the common carotid, 21,22 external carotid, 9,10,20,23 internal carotid, 1,11,22,24,25 internal maxillary, 19 lingual, 26 and proximal facial artery. 15 Most of the few reported cases originated from the distal facial [4][5][6][7][8]16,17 or the superficial temporal arteries.…”

“…rare are PAs of deeper vessels, such as the common carotid, 21,22 external carotid, 9,10,20,23 internal carotid, 1,11,22,24,25 internal maxillary, 19 lingual, 26 and proximal facial artery. 3 We present an unusual case of a PA of the proximal facial artery presenting as oropharyngeal hemorrhage, one month after a through-andthrough gunshot wound to the neck traversing zones II and III.…”

Treatment of a Recurrent Internal Carotid Artery Pseudoaneurysm with the Wallgraft Endoprosthesis

“…However, outcomes in patients with dissection related aneurysms due to blunt trauma show a low incidence of spontaneous resolution on conservative management 11 . Thromboembolic complications are also well described 9,12,13 and may manifest some time after the initial traumatic event 14 . Therefore obliteration of the aneurysm is the ultimate aim of successful treatment.…”

The Role of Clinical Examination in Excluding Vascular Injury in Haemodynamically Stable Patients with Gunshot Wounds to the Neck. A Prospective Study of 59 Patients

“…13 Unfortunately, there are no conclusive studies in this field, although recommendations have been made in accumulated overviews. 14,15 Transmural traumatic arterial injuries of major vessels can result in serious delayed complications months or even years after the injury. 9,16 The evaluation and management of penetrating injuries to the neck are evolving.…”