Hybrid Open and Endovascular Management of a Gunshot Wound to the Carotid Artery

Abstract

In addition to standard open surgical techniques, major hemorrhage is increasingly being managed using hybrid (open and endovascular) surgery. We present a case of hybrid management of a carotid artery injury secondary to an oropharyngeal gunshot wound. After performing balloon catheter tamponade with an inflated intraoral Foley catheter, on-table transfemoral angiography demonstrated extravasation from the external carotid artery with arteriovenous fistulization to the internal jugular vein. An endovascular stent graft was deployed, spanning from the common carotid to the internal carotid artery. This facilitated surgical neck exploration and ligation of the external carotid artery and jugular vein injury in zone II/III of the neck while maintaining antegrade cerebral blood flow. The approach presented represents a feasible and effective means to manage these types of difficult-to-access injuries in the endovascular and hybrid surgical era.