1157 A Giant Pseudoaneurysm of Carotid Artery

Abstract Introduction Pseudoaneurysm(PA) post carotid endarterectomy(CEA) is infrequent and potentially lethal complication, with incidence rate of less than 1%. Most of the described case reports are associated with infection. We present a case of 73-year-old man with a giant left carotid pseudoaneurysm post bilateral CEA. Case Presentation A 73 year old man presented with pulsatile left neck swelling after 17 years of left CEA, also had right CEA 13 years ago. Swelling was pulsatile and gradually increased in size. Initial ultrasound(USS) showed anteroposterior diameter of 1.5cm carotid pseudoaneurysm associated with patch. Decision of embolisation with stenting was made in vascular multidisciplinary-team(MDT) meeting however, patient declined the treament at that time. Following year, size of the swelling progressed, now tender and causing dysphagia. CT-Angiogram demonstrated giant left carotid bulb pseudoaneurysm. Open surgical repair with revision patch angioplasty was performed after the patient agreed. Post operative day-2 patient developed large neck haematoma which was managed conservatively and showed good recovery in follow-up clinic. Discussion The most common cause of pseudoanuerysm is trauma or previous surgery. However, presentation after many years of surgery without any signs of infection makes our case interesting. Conclusions Carotid artery pseudoaneurysm can be life-threatening if not diagnosed early. Any neck swelling should be investigated vigorously regardless of any previous trauma or surgery.