Management of carotid injuries in a hostile neck using endovascular grafts

Pseudoaneurysms and iatrogenic injuries of the extracranial carotid artery are not common but represent unique operative challenges with associated high morbidity and mortality. We report two cases in which a Wallgraft was used via percutaneous femoral access to treat such injuries. In the first, a 6-cm carotid pseudoaneurysm was successfully excluded by coil embolization of the external carotid artery and stent grafting across the carotid bifurcation. In the second case, an endovascular graft was used to treat an intraoperative common carotid injury in a re-operated, radiated neck. These cases demonstrate the utility of endovascular graft treatment of emergent carotid injuries.