Law Yuk, Chan Yiu Che, Cheng Stephen W
Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, Queen Mary Hospital, Hong Kong, China.
World J Emerg Med. 2015;6(3):229-32. doi: 10.5847/wjem.j.1920-8642.2015.03.013.
Delayed presentation of carotid artery pseudoaneurysm following many years after self-inflicted penetrating injury of the neck is extremely rare. Open surgical carotid repair may involve sternotomy for proximal vascular control. Endovascular treatment is evolving as a less-invasive treatment option.
We report a 55-year-old man with a history of paranoid schizophrenia who presented with a progressively enlarging left sided neck mass many years after attempted suicide. CT scan confirmed a 6 cm pseudoaneurysm arising from the common carotid artery.
Through an open retrograde puncture of the distal common carotid artery, the common carotid pseudoaneurysm was successfully repaired with a BARD fluency carotid stentgraft of 8 mm×80 mm (BARD, Tempe, AZ). The patient recovered well with no neurological deficits and was discharged on postoperative day 4. Dual antiplatelet agents of aspirin and clopidogrel were given for six months and then clopidogrel was administered lifelong. The neck mass decreased in size gradually and became non pulsatile upon follow-up.
Endovascular stenting of giant carotid pseudoaneurysm is an acceptable less invasive treatment option for giant carotid pseudoaneurysm. Long-term follow-up and a greater number of cases are mandatory to establish the safety of this strategy.
颈部自伤性穿透伤多年后出现颈动脉假性动脉瘤极为罕见。开放性手术修复颈动脉可能需要开胸进行近端血管控制。血管内治疗作为一种侵入性较小的治疗选择正在不断发展。
我们报告一名55岁有偏执型精神分裂症病史的男性，他在自杀未遂多年后出现左侧颈部肿块且逐渐增大。CT扫描证实颈总动脉有一个6厘米的假性动脉瘤。
通过对颈总动脉远端进行开放逆行穿刺，使用一个8毫米×80毫米的BARD流畅型颈动脉支架移植物（BARD，坦佩，亚利桑那州）成功修复了颈总动脉假性动脉瘤。患者恢复良好，无神经功能缺损，术后第4天出院。给予阿司匹林和氯吡格雷双联抗血小板药物治疗6个月，然后终身服用氯吡格雷。随访时颈部肿块逐渐缩小且不再搏动。
血管内支架置入术治疗巨大颈动脉假性动脉瘤是一种可接受的侵入性较小的治疗选择。必须进行长期随访并积累更多病例以确定该策略的安全性。
