Common Carotid Artery Mycotic Pseudoaneurysms: Two Case Reports

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Extracranial infected carotid artery aneurysm (EICA) is rare, but requires rapid surgical repair due to the risk of multiple complications, including rupture. We report two cases of surgical repair of EICA.Case 1: A 63-year-old man had a misplaced central venous catheter in the right common carotid artery two weeks ago. He presented with a subcutaneous tumor in the right cervical region. A contrast-enhanced computed tomography (CT) scan revealed a right common carotid artery mycotic pseudoaneurysm. Emergency surgery was performed because of rapid enlargement of the aneurysm. The mycotic pseudoaneurysm and the common carotid artery were repaired by suturing the defect in the arterial wall. The arterial wall around the defect was fragile. The postoperative course was uneventful.Case 2: A 54-year-old man presented with a subcutaneous tumor in the left cervical region after symptoms of common cold. A contrast-enhanced CT scan revealed a left common carotid artery mycotic pseudoaneurysm. He developed thyrotoxicosis caused by destructive thyroiditis. Emergency surgery was performed due to enlargement of aneurysm, observed on follow-up CT. The mycotic pseudoaneurysm and the common carotid artery were repaired using a venous graft. The arterial wall around the defect was fragile. The postoperative course was uneventful.An important finding was that the size of the defect in the arterial wall during surgery was estimated to be larger than that assessed during preoperative evaluation in cases of mycotic aneurysms.

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