PMC4927288_01
Axial CT angiogram image of the proximal carotid artery with bullet artifact interfering with image interpretation.. CT: computed tomography.
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Computed tomography (CT) angiogram of the neck and chest was then performed, showing the left neck hematoma mentioned previously along with bullet fragment artifact that interfered with image interpretation at the level of the left distal common carotid (CCA) and proximal internal carotid arteries (ICA) (Figure 1).
3D reconstruction of CT angiogram of the neck showing a 6-cm proximal internal carotid pseudoaneurysm.. 3D: three-dimensional; CT: computed tomography.
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He was hemodynamically stable and underwent repeat CT angiogram of the neck (see Figure 2).
Intra-operative picture of the pseudoaneurysm with proximal control of the common carotid artery.
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Secondary to the proposed mass effect by the hematoma/pseudoaneurysm complex on the neighboring nerves and hypopharynx, decision was made to manage this with an open procedure to evacuate the hematoma (Figure 3).
Intra-operative picture of common carotid artery to internal carotid artery bypass with reversed great saphenous vein.
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The patient underwent an end-to-end left CCA to left ICA bypass with reversed great saphenous vein, and ligation of the left external carotid artery (Figure 4).