Smelt J L C, Alhamarneh O, Dyer J D, Liew L
Department of Ear Nose and Throat, New Cross Hospital, Wolverhampton, UK.
J Laryngol Otol. 2012 Feb;126(2):214-6. doi: 10.1017/S0022215111002866. Epub 2011 Oct 18.
(1) To highlight the significance of carotid artery pseudoaneurysm as a rare complication following neck dissection, and (2) to suggest endovascular coiling as management, in the presence of infection, previous radiotherapy and a grafted blood supply.
A 66-year-old man diagnosed with squamous cell carcinoma of the hypopharynx and upper oesophagus underwent pharyngolaryngectomy with reconstruction of a neo-pharynx using a free jejunal graft. The patient had previously received radiotherapy for a soft palate squamous cell carcinoma. Two months after surgery, computed tomography demonstrated a bilobed pseudoaneurysm of the left external carotid artery just distal to the arterial branch supplying the jejunal graft. This mycotic pseudoaneurysm was successfully treated with endovascular coiling, while maintaining the patency of the superior thyroid artery supplying the jejunal graft anastomosis.
In this patient, endovascular coiling of the external carotid artery was considered to be the only definitive treatment for a life-threatening mycotic pseudoaneurysm.
（1）强调颈动脉假性动脉瘤作为颈部清扫术后罕见并发症的重要性，以及（2）在存在感染、既往放疗和移植血供的情况下，建议采用血管内栓塞术进行治疗。
一名66岁男性，诊断为下咽和上段食管癌，接受了咽喉切除术，并用游离空肠移植重建新咽。该患者曾因软腭鳞状细胞癌接受过放疗。术后两个月，计算机断层扫描显示左颈外动脉在供应空肠移植的动脉分支远端有一个双叶假性动脉瘤。这个霉菌性假性动脉瘤通过血管内栓塞术成功治疗，同时保持了供应空肠移植吻合口的甲状腺上动脉的通畅。
在该患者中，颈外动脉血管内栓塞术被认为是治疗危及生命的霉菌性假性动脉瘤的唯一确定性治疗方法。
