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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.

 Joon Hyuk Kong  ;  Sang Min Park  ;  Tae Hoon Kim  ;  Dong Hoon Choi  ;  Do Yun Lee 
 ANNALS OF VASCULAR SURGERY, Vol.24(7) : 955-10, 2010 
Journal Title
Issue Date
Aged ; Aneurysm, False/etiology ; Aneurysm, False/surgery* ; Angiography, Digital Subtraction ; Arteriovenous Fistula/etiology ; Arteriovenous Fistula/surgery* ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation*/instrumentation ; Carotid Artery Injuries/etiology ; Carotid Artery Injuries/surgery* ; Endovascular Procedures*/instrumentation ; Heart Failure/etiology* ; Humans ; Jugular Veins/injuries ; Jugular Veins/surgery* ; Male ; Stents ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Wounds, Gunshot/complications*
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hoon(김태훈)
Park, Sang Min(박상민)
Lee, Do Yun(이도연)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
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