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

Joon Hyuk Kong, Sang Min Park, Tae Hoon Kim, Dong Hoon Choi, Do Yun Lee

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)955.e5-955.e10
JournalAnnals of Vascular Surgery
Volume24
Issue number7
DOIs
Publication statusPublished - 2010 Oct

Fingerprint

False Aneurysm
Fistula
Stents
Neck
Heart Failure
Transplants
Angiography
Thrombosis
Tomography
Penetrating Wounds
Therapeutics
Tricuspid Valve Insufficiency
Common Carotid Artery
Jugular Veins
Chest Pain
Pulmonary Embolism
Stroke Volume
Dyspnea
Nervous System
Accidents

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "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",
abstract = "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.",
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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. / Kong, Joon Hyuk; Park, Sang Min; Kim, Tae Hoon; Choi, Dong Hoon; Lee, Do Yun.

In: Annals of Vascular Surgery, Vol. 24, No. 7, 10.2010, p. 955.e5-955.e10.

Research output: Contribution to journalArticle

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