A case report of placing covered stent for bile duct by pull through technique for iatrogenic pseudoaneurysm of common carotid artery

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  • 医原性総頚動脈仮性瘤に対してプルスルーテクニックにて胆管用カバードステントを留置した１例

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<p>Psuedoaneurysm of common carotid artery (CCA) is rare complication of cervical surgery, radiation and infection but is life–threatening by its rupture. Although surgical treatment has been the first–line treatment for such hemorrhage, in some cases, transarterial embolization or bare stent placement is performed. If the hemostasis is insufficient by these treatment, placement of covered stent is an option. However, stiffness of the covered stent and sharp angle of the aorta and the left CCA often make it difficult to deliver the covered stent. We report a case of hemorrhage from pseudoaneurysm of CCA successfully treated with covered stent placement using pull through technique between the femoral artery (FA) and the superficial temporal artery (STA).</p><p>A 69–year–old man with esophageal carcinoma who had undergone chemotherapy and 60 Gy radiotherapy (2 Gy × 30 times) 2 years before, salvage surgery 32 days before, and drainage for the mediastinal abscess 9 days before had an episode of sudden hemorrhage via the drain and cervical swelling. Angiography showed aneurysm–like finding at left CCA, 7 cm distal from the origin, but not whole aneurysm was visible. So, it seemed to be a dissecting psuedoaneurysm. Because the surgery treatment was very difficult due to high adhesion and invisible whole aneurysm, we planned covered stent placement. But it was difficult to deliver the covered stent due to stiffness of covered stent and the sharp angle of aorta and left CCA. Finally, we could deliver the covered stent with pull through technique between the FA and the STA and completed the procedure to get hemostasis.</p><p>Pull through technique may facilitate safe and stable covered stent delivery to stop hemorrhage from iatrogenic pseudo­aneurysm of common carotid artery.</p>

Journal

  • Neurotraumatology

    Neurotraumatology 42 (1), 50-53, 2019-08-20

    The Japan Society of Neurotraumatology

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