A Case of Common Carotid Artery Pseudoaneurysm Repair: An Anaesthetic Challenge

Pseudoaneurysms of the extracranial common carotid artery are rare but potentially life-threatening vascular lesions that may present with airway compromise, embolic events, cranial nerve palsy or rupture. Surgical repair is technically challenging because of maintenance of cerebral perfusion during carotid cross clamping. The present study describes the successful management of a patient undergoing repair of a giant common carotid artery pseudoaneurysm. A 56-year-old male patient, known hypertensive and chronic smoker was planned for surgical repair of pseudoaneurysm of left common carotid artery. Extracranial carotid artery pseudoaneurysms are uncommon but potentially catastrophic because they may rupture, embolise, or compress the airway and adjacent cranial nerves. Aetiological factors like mycotic pseudoaneurysms, fibromuscular dysplasia and Behçet’s disease (triad of mouth, genital ulcers and relapsing iritis) have also been reported. Histologically aneurysms have been divided into two types: True aneurysms and pseudoaneurysms. Pseudoaneurysms are more common and develop when entire arterial wall is lacerated and surrounded by a haematoma. Large pseudoaneurysm may produce vascular impairment to the head and neck and airway distortion. The neck swelling was impinging upon and displacing the trachea. The huge neck swelling and tracheal deviation poses challenges to anaesthesiologists in airway management. The affected carotid artery was clamped during the repair. The present case highlights the precautions taken, the detection and the strategies for preventing the impending cerebral insult during such surgeries whenever the carotid artery is clamped. The present case is distinctive because a giant pseudoaneurysm causing airway displacement and vocal cord palsy was successfully repaired despite coexisting ventricular dysfunction and anaemia, using controlled airway instrumentation, short shunt-supported carotid clamping, and immediate neurological assessment.