A Case of Pseudoaneurysm of the Common Carotid Artery Presented with Upper Airway Obstruction
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CASE REPORT
A Case of Pseudoaneurysm of the Common Carotid Artery Presented with Upper Airway Obstruction Maja Vizjak 1
&
Dino Strlek 1 & Danijel Cvetko 2 & Maja Ljubotina 1
Received: 31 July 2020 / Accepted: 29 October 2020 # Association of Surgeons of India 2020
Abstract Extracranial carotid artery aneurysms account for only 1% of all arterial aneurysms and therefore they are quite rare pathology. Patients with those aneurysms present with a pulsatile neck mass, neurological events such as a stroke and a cranial nerves dysfunction due to compression effects. Because of the high risk of a rupture and thromboembolic events, it is recommended to repair these aneurysms either utilizing open surgical or endovascular approach. This report details a case of a female patient with a common carotid artery pseudoaneurysm presented with upper airway obstruction. Tracheotomy was performed as a lifesaving procedure. We opted for an endovascular management because of the existing tracheostomy that could complicate surgical approach. Pseudoaneurysm was successfully managed with an endovascular deployment of self-expanding stent graft. Keywords Carotid artery . Pseudoaneurysm . Respiratory failure . Tracheotomy
Case report An 86-year-old lady presented in the emergency department because of the breathing difficulties. The right side of her neck was swelling and her respiratory status was rapidly declining. She was examined by an otorhinolaryngologist. The rima glottidis was not available for an inspection. Regarding her clinical presentation of acute airway obstruction, patient was immediately intubated to secure the airway. Emergency tracheotomy was indicated by the otorhinolaryngologist. After the procedure, the patient was respiratory sufficient and hemodynamically stable. After the airway was secured, further clinical investigation on her neck mass and breathing difficulties was conducted. Patient suffered from dementia and most of her anamnestic data were obtained from previous medical records. She denied any previous trauma to the neck region or surgery in that area. In her medical records, there were no signs of connective
* Maja Vizjak [email protected] 1
Department of Surgery, General Hospital Varazdin, Ivana Mestrovica 1, 42000 Varazdin, Croatia
2
Clinical Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
tissue disorders or radiotherapy. She was diagnosed with hypothyroidism and years long arterial hypertension and rheumatoid arthritis. Computed tomography of neck and thorax showed an expansive formation indivisible of the common carotid artery compressing trachea and esophagus to the left. Computed tomography angiography of carotid arteries was performed as a next step and it revealed a 40 × 25-mm large pseudoaneurysm (PSAN) of the right common carotid artery (CCA). The PSAN aroused from a 1.5-mm long rupture of the medial wall of the common carotid artery located 30mm caudal to the bifurcation (Figs. 1 and 2). Two approaches for pseudoaneurysm management were considered: open surgical and
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