Infected carotid pseudoaneurysm and carotid-cutaneous fistula as a late complication of carotid artery stenting

• Published in: Journal of vascular surgery 2006-02, Vol.43 (2), p.379-382
• Main Authors: Kaviani, Amir, Ouriel, Kenneth, Kashyap, Vikram S.
• Format: Article
• Language: English
• Subjects: Aged; Amaurosis Fugax - etiology; Aneurysm, False - complications; Aneurysm, False - etiology; Aneurysm, False - pathology; Aneurysm, False - surgery; Aneurysm, Infected - complications; Aneurysm, Infected - etiology; Aneurysm, Infected - pathology; Aneurysm, Infected - surgery; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Biological and medical sciences; Carcinoma, Mucoepidermoid - radiotherapy; Carcinoma, Mucoepidermoid - surgery; Carotid Artery Diseases - complications; Carotid Artery Diseases - etiology; Carotid Artery Diseases - pathology; Carotid Artery Diseases - surgery; Carotid Stenosis - etiology; Carotid Stenosis - therapy; Cutaneous Fistula - complications; Cutaneous Fistula - etiology; Cutaneous Fistula - pathology; Cutaneous Fistula - surgery; Fatal Outcome; Humans; Male; Medical sciences; Neck Dissection - adverse effects; Neurology; Neurosurgery; Oropharyngeal Neoplasms - radiotherapy; Oropharyngeal Neoplasms - surgery; Radiotherapy - adverse effects; Saphenous Vein - transplantation; Severity of Illness Index; Skull, brain, vascular surgery; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vascular Fistula - complications; Vascular Fistula - etiology; Vascular Fistula - pathology; Vascular Fistula - surgery; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2005.10.058

Carotid stenosis after neck irradiation is a well-described entity. A 78-year-old man presented with left eye amaurosis fugax 11 years after radical neck dissection and neck irradiation for mucoepidermoid carcinoma. The patient underwent carotid artery stenting for a high-grade stenosis of the left internal carotid artery. Twenty months after the procedure, a pulsatile neck mass developed with intermittent arterial bleeding. After control of the bleeding, he underwent resection of the left carotid bifurcation, including the indwelling stent and reconstruction with a saphenous vein interposition graft. A pectoralis myocutaneous flap was used for wound closure. In this case, localized infection of the stented carotid artery led to mycotic degeneration, pseudoaneurysm formation, and erosion to the skin surface. As carotid artery stenting becomes more widely used, previously unreported late complications associated with this procedure are likely to become apparent, and continued close follow-up is warranted.