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• W2133207181 abstract "A 74-year-old man presented with a pulsatile right neck mass that was painful with left neck rotation. His surgical history was significant for a right carotid endarterectomy with a bovine patch angioplasty 2 years earlier. Physical examination confirmed a nontender pulsatile right neck mass without focal neurologic deficit. A carotid angiogram (anteroposterior and lateral, A [Cover] and B) revealed a 5-cm × 6-cm pseudoaneurysm in the internal carotid artery arising from the distal bovine carotid patch, which corresponded to the level of the C1 vertebrae. Because of the large pseudoaneurysm size in a scarred neck region as well as the high anatomical location, an endovascular treatment was performed. Following the placement of a Shuttle sheath (Cook, Bloomington, Ind) in the right common carotid artery from a right groin approach, a 0.018-inch guidewire (Boston Scientific, Natick, Mass) was used to cross the internal carotid artery. An 8-mm × 50-mm Wallgraft (Boston Scientific) was deployed across the carotid bifurcation which successfully excluded the carotid artery pseudoaneurysm. Completion angiogram showed complete obliteration of the pseudoaneurysm along with exclusion of the external carotid artery (C). No complications occurred related to the procedure, and the patient was discharged home 2 days later. Follow-up carotid duplex scan at 18 months confirmed the stent-graft patency without evidence of endoleak or restenosis. The pseudoaneurysm mass was significantly reduced in size (2 cm × 2.5 cm), and the compressive symptom had resolved completely at that time. Complications of bovine vascular graft placement include infection, thrombosis, and pseudoaneurysm formation.1Brems J. Castaneda M. Garvin P.J. A five-year experience with the bovine heterograft for vascular access.Arch Surg. 1986; 121: 941-944Crossref PubMed Scopus (25) Google Scholar The pathogenesis of the latter complication is related to graft deterioration. Our case is unusual due in part to the short-term pseudoaneurysm development following carotid bovine patch placement. Moreover, this represents the first reported case of carotid pseudoaneurysm formation following bovine patch angioplasty in a carotid endarterectomy. The utility of a covered stent in the management of arterial pseudoaneurysm is well described, particularly in the trauma literature.2Weiss V.J. Chaikof E.L. Endovascular treatment of vascular injuries.Surg Clin North Am. 1999; 79: 653-665Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar The main advantage of this treatment approach in our patient relates to the ability to exclude the pseudoaneurysm while avoiding the surgical challenge of operating in a scarred neck region and obtaining high cervical exposure. At the time of this patient’s treatment, the Wallgraft device was the only viable option, since an alternative device, the Viabahn stent-graft (WL Gore, Flagstaff, Ariz), was not yet available. Although the AneuRx stent-graft (Medtronic, Sunnyvale, Calif) was commercially available for iliac application, the device shaft was too short for carotid application. When evaluating a patient with carotid pseudoaneurysm for possible endovascular repair, it is important to delineate the origin of the external carotid artery and the pseudoaneurysm neck. If the external carotid artery arises in the vicinity of the pseudoaneurysm, it is necessary to first embolize the external carotid artery with coils prior to stent-graft placement. Otherwise the external carotid artery will become a source of endoleak which may lead to subsequent pseudoaneurysm expansion. The risks of external carotid embolization include facial weakness and exertional pain associated with chewing. The imaging studies in our patient identified that the pseudoaneurysm neck originated from the distal carotid bovine patch in the internal carotid artery, which was well away from the external carotid artery. Therefore, endovascular treatment using a stent graft predictably resulted in the successful pseudoaneurysm exclusion without external carotid artery endoleak." @default.
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• W2133207181 date "2003-08-01" @default.
• W2133207181 modified "2023-09-28" @default.
• W2133207181 title "Successful stent-graft exclusion of a bovine patch-related carotid artery pseudoaneurysm" @default.
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• W2133207181 doi "https://doi.org/10.1016/s0741-5214(03)00428-2" @default.
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