Management of ruptured pseudoaneurysm of the right common carotid artery in a resource-limited setting (Case report)

Abstract

Carotid artery injuries with pseudo-aneurysm are uncommon but associated with central neurologic dysfunction. We present a 26-year-old man with a giant bleeding pseudo-aneurysm of right common carotid artery managed by emergency sternotomy, neck exploration and repair of the aneurysm. On the right side of the neck was a 10 × 8 cm mass occupying almost the entire posterior triangle. It was pulsatile, tender with sinus discharging serosanguinous fluid. Positive thrill and bruit were demonstrable over the mass. Conventional Computerized Angiography (CTA) and Distal Subtraction Angiography (DSA) showed a 1 cm defect in the lateral wall of the distal right common carotid artery (RCCA), complete circle of Willis and massive blood clot at the site of the defect. In middle-and low-income settings where the technical know-how and resources for stenting including cerebral oximeter are not available, expertise in open surgical approach becomes the only way to save life. Key words: Diagnosis, equipment, surgery, treatment, pseudoaneurysm, carotid artery, rupture.