Background: We report the percutaneous endovascular management of an iatrogenic perforation of the left common carotid artery (LCCA) during an attempted trans-subclavian pacemaker (PM) placement. Methods: An 87-year-old woman was urgently transferred after an attempted left subclavian vein PM implantation. Computed tomography angiography scan showed the accidental cannulation of LCCA in its most proximal segment. Owing to the significant surgical risks, the mortality rate, and the distal position of the vessel from the skin, we opted for an endovascular strategy with a balloon-expandable stent graft. The Advanta 8 × 38 mm V12 was inserted via a 7 French Flexor Introducer sheath through the right common femoral artery. Results: The patient was discharged on postoperative day 2 without complications. A 6-month follow-up computed tomography angiography demonstrated stent graft and LCCA patency and the patient was in a good stable condition. Conclusions: This case highlights the effectiveness of a minimal invasive endovascular approach to treat this uncommon but potentially lethal injury.

Endovascular Repair of a Common Carotid Artery Perforation during Pacemaker Insertion

Palermo S.;Faggioli G.;Ancetti S.;Gallitto E.;Logiacco A.;Pini R.;Gargiulo M.
2020

Abstract

Background: We report the percutaneous endovascular management of an iatrogenic perforation of the left common carotid artery (LCCA) during an attempted trans-subclavian pacemaker (PM) placement. Methods: An 87-year-old woman was urgently transferred after an attempted left subclavian vein PM implantation. Computed tomography angiography scan showed the accidental cannulation of LCCA in its most proximal segment. Owing to the significant surgical risks, the mortality rate, and the distal position of the vessel from the skin, we opted for an endovascular strategy with a balloon-expandable stent graft. The Advanta 8 × 38 mm V12 was inserted via a 7 French Flexor Introducer sheath through the right common femoral artery. Results: The patient was discharged on postoperative day 2 without complications. A 6-month follow-up computed tomography angiography demonstrated stent graft and LCCA patency and the patient was in a good stable condition. Conclusions: This case highlights the effectiveness of a minimal invasive endovascular approach to treat this uncommon but potentially lethal injury.
Palermo S.; Faggioli G.; Ancetti S.; Gallitto E.; Logiacco A.; Pini R.; Gargiulo M.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/800454
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