Document Detail


Late-onset congestive heart failure in a patient with a 58-year-old huge traumatic carotid-jugular fistula and pseudoaneurysm: endovascular treatment with a stent-graft.
MedLine Citation:
PMID:  20832001     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We report a case of successful stent-graft endovascular treatment of a huge traumatic carotid-jugular fistula with a pseudoaneurysm that had resulted from a bullet injury. A 77-year-old man with a pulsatile neck mass came to our hospital complaining of dyspnea and chest pain at rest; about 58 years ago, a gunshot accident had inflicted a penetrating bullet wound on the right side of his neck. Computerized tomography angiogram had demonstrated a huge vascular mass protruding into the right anterior neck with a pseudoaneurysm. The calcified pseudoaneurysm had an oval-shaped opening in the right common carotid artery, with a large base into the right internal jugular vein. Echocardiography showed deteriorating congestive heart failure, wherein left ventricular (LV) enlargement with a LV end-diastolic diameter of 6.1 cm, severe tricuspid valve regurgitation, and LV ejection fraction of 60% was seen. The surgical approach was considered risky because of the severe deformity of the native vasculature, the severe calcified pseudoaneurysm, and the context of advanced age with congestive heart failure. Thus, we decided to treat this patient with endovascular devices. Fortunately, a stent-graft was delivered successfully across the carotid-jugular fistula and immediate follow-up angiogram demonstrated a small filling defect at the base of stent-graft representing thrombus. The follow-up computerized tomography angiograms obtained 2 weeks and 4 months later further demonstrated a patent stent-graft, no evidence of thrombus progression, and no abnormal shunt flow. The patient did not experience any neurologic complications nor did he show any evidence of pulmonary embolism for 8 months.
Authors:
Joon Hyuk Kong; Sang Min Park; Tae Hoon Kim; Dong Hoon Choi; Do Yun Lee
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  955.e5-955.e10     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular and Thoracic Surgery, Daegu Veterans Hospital, Daegu, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aneurysm, False / etiology,  surgery*
Angiography, Digital Subtraction
Arteriovenous Fistula / etiology,  surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / instrumentation
Carotid Artery Injuries / etiology,  surgery*
Endovascular Procedures* / instrumentation
Heart Failure / etiology*
Humans
Jugular Veins / injuries,  surgery*
Male
Stents
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Wounds, Gunshot / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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