Infected carotid pseudoaneurysm and carotid-cutaneous fistula as a late complication of carotid artery stenting Amir Kaviani, MD, Kenneth Ouriel, MD,

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Presentation transcript:

Infected carotid pseudoaneurysm and carotid-cutaneous fistula as a late complication of carotid artery stenting Amir Kaviani, MD, Kenneth Ouriel, MD, Vikram S. Kashyap, MD Journal of Vascular Surgery Volume 43, Issue 2, Pages 379-382 (February 2006) DOI: 10.1016/j.jvs.2005.10.058 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Selective left carotid arteriography before carotid artery stenting reveals a high-grade carotid bifurcation stenosis in a patient with amaurosis fugax. Journal of Vascular Surgery 2006 43, 379-382DOI: (10.1016/j.jvs.2005.10.058) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Photograph of the patient’s left neck 20 months after carotid artery stenting. A pulsatile mass developed in the patient’s left neck, with bleeding from an area of recent skin breakdown. Note that the patient had undergone radical neck dissection followed by neck irradiation for carcinoma of the oropharynx many years previously and had an indurated and fibrotic neck. Journal of Vascular Surgery 2006 43, 379-382DOI: (10.1016/j.jvs.2005.10.058) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Selective left carotid arteriography revealed two pseudoaneurysms at the proximal external carotid artery. The external carotid artery was occluded by coil embolization through the tines of the stent, with cessation of bleeding. Journal of Vascular Surgery 2006 43, 379-382DOI: (10.1016/j.jvs.2005.10.058) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Operative dissection at the time of left carotid resection and reconstruction using a saphenous vein interposition graft. The pseudoaneurysm had eroded to the skin surface, causing a carotid-cutaneous fistula. Note the coils present in the thrombosed external carotid artery. Minimal soft tissue was present, and a pectoralis myocutaneous flap was necessary for coverage. Journal of Vascular Surgery 2006 43, 379-382DOI: (10.1016/j.jvs.2005.10.058) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions