Nail Gun Injury and Endovascular Repair of Cervical Internal Carotid Artery

A male patient aged 49 years presented to the emergency room after sustaining a nail-gun injury to the left neck (Zone III). Computed tomography (CT) angiogram demonstrated retained nail traversing in close proximity to the left internal carotid artery. Catheter angiogram with three-dimensional (3D)...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2019-03, Vol.11 (3), p.e4237
Main Authors: Brzezicki, Grzegorz, Meyer, Travis E, Madbak, Firas, Widrich, Jason, Jensen, Abbie
Format: Article
Language:English
Subjects:
Angioplasty
Carotid arteries
Case reports
Injuries
Medical imaging
Medicine
Mortality
Neurosurgery
Patients
Stents
Surgery
Tomography
Trauma
Veins & arteries
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Summary:A male patient aged 49 years presented to the emergency room after sustaining a nail-gun injury to the left neck (Zone III). Computed tomography (CT) angiogram demonstrated retained nail traversing in close proximity to the left internal carotid artery. Catheter angiogram with three-dimensional (3D) reconstruction revealed partial left internal carotid injury without active extravasation and with preserved flow through the vessel. The nail was removed by gentle traction with the simultaneous deployment of stent-graft across the injured segment. Balloon angioplasty of the stent was performed secondary to endoleak and active extravasation. Complete vessel reconstruction with maintained blood flow was achieved. The patient was extubated the following day and was discharged home on hospital day five without neurological deficits. This case report demonstrates the usefulness of endovascular repair of high cervical arterial injuries with special attention to the unique nature of nail gun injuries.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.4237