Common Carotid Artery (CCA) pseudoaneurysms are uncommon vascular lesions. They are most likely to occur as a sequelae of previous neck surgery (CEA incidence <1%), blunt or penetrating injuries to the neck, cancer with radiation necrosis, iatrogenic, mycotic and fibromuscular dysplasia than spontaneously. Formation of CCA pseudoaneurysm post CEA can occur anytime from 2 days to 22 years and is attributed to wound dehiscence, suture failure, and arterial wall breakdown resulting from infection and the quality of the graft. We report the case of a neurologically asymptomatic 75-year-old male who developed an impressive, pulsatile pseudoaneurysm of the Right CCA 1 year after having bilateral CEA. There was less deliberation in his management options for he was referred to us by his General Vascular Surgeon. Angiograms revealed a 20.3 mm × 27.8 mm RCCA pseudoaneurysm that was rendered impotent using selective catherization with stent and coil embolization. Two weeks after discharge, he returned with a ruptured RCCA pseudoaneurysm and extravasations of blood through his previous incision site (CEA). New angiograms not only confirmed the stability of the 2 week old coils and stent construct but revealed a patent flow area inferior to the coils and posterior to the stent. This was again managed endovascularly using more coiling. Complete control of the pseudoaneurysm without any hemodynamic compromise was achieved and the patient was discharged home neurologically intact with no signs of infection. After 1 week, he returned with active pulsatile recalcitrant hemorrhage. This life threatening exsanguination was controlled by sacrificing the Right CCA (Parent Artery Sacrifice) after performing a Balloon Test Occlusion. This case brings to light an uncommon pathology, the complexity of its management, endovascular vs open surgical options, and the futile but systemic attempt to spare the parent artery.
Competing interests None.
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