Reconstruction of carotid artery pseudoaneurysm in an intravenous drug user with multiple needles in the neck

Abstract

Introduction: There are very few intravenous drug abuse-related carotid pseudoaneurysm cases reported in the literature. We report a case of a carotid pseudoaneurysm reconstruction with vascular allograft due to recurrent infection caused by frequent cervical self-punctions, and a subsequent recurrent septic pseudoaneurysm formation.Case report: A 45-year-old iv. heroin user male patient was admitted to our department. The left cervical region became swollen causing dyspnea and showed pulsation. The CT angiography revealed broken needles in both cervical regions and a left common carotid artery pseudoaneurysm with a diameter of 5 cm that caused dislocation of the trachea. We performed an urgent resection of the pseudoaneurysm and reconstruction with a cryopreserved human arterial allograft. Two months later the patient returned to our unit with dyspnea, dizziness, fever and a pulsating cervical mass at the operative site following repeated drug abuse, and the direct puncture of the vascular allograft. The ultrasound examination showed a contained rupture at the proximal anastomosis. During his preparation for the urgent surgery he suffered a stroke causing right hemiplegia and aphasia. We occluded the common carotid artery with an Amplatzer vascular plug and the hematoma was evacuated.Discussion: Cervical foreign bodies rarely cause recurrent carotid pseudoaneurysm. An endovascular occlusion of the common carotid artery was necessary for anastomotic disruption of allograft placed for a common carotid pseudoaneurysm. Conclusion:Patients with infected carotid artery pseudoaneurysm should be treated by open or endovascular methods to prevent stroke or any life-threatening complications.