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Carotid artery pseudoaneurysm

A carotid artery pseudoaneurysm can refer to a pseudoaneurysm involving any segment of the carotid artery.

Pathology

As with pseudoaneurysms elsewhere, these lack all three layers of the arterial wall (intima, media and adventitia).

Pseudoaneurysm development can occur within hours to several years after initial arterial injury although normally presenting within 5 years 7.

Carotid arterial pseudoaneurysms can involve the following types depending on the portion of vessel involved

Causes

Pseudoaneurysms can arise from varying causes which include

  • trauma
    • penetrating trauma
    • blunt trauma
  • arterial dissection
  • vasculitides
  • infection - e.g. mycotic carotid arterial pseudoaneurysm 14
  • as an iatrogenic complication following procedures
    • following carotid endarterectomy - uncommon complication 5,7
    • following transsphenoid  surgery - ICA pseudoaneuysm formation - rare 9
    • surgical neck dissections -  rare 11-12
    • misplaced cenral venous lines -  rare 10

Radiographic features

Imaging evaluation is often with Doppler ultrasound and CT angiography.

Treatment and prognosis

Management options can range from traditional surgical repair to endovascular repair (stent placement -  combined stent placement and coil embolisation 7). Mortality rates of up to 30% have been reported in the case of external carotid arterial pseudo aneurysms. In certain situations more conservative parroahces are taken (i.e observation 13)

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