Rapid Communication| Volume 44, ISSUE 3, e27-e30, March 2009

External-internal carotid artery transposition for repair of multiple pseudoaneurysms from penetrating injury in a pediatric patient


      A 13-year-old boy was transferred to our trauma center after sustaining a shotgun wound to his neck and head. Workup revealed an injury to his tonsillar fossa, a pseudoaneurysm less than 4 mm in his internal carotid artery, and diffuse cerebral edema. After management of his intracranial hypertension, follow-up angiogram revealed 4 pseudoaneurysms in his internal carotid artery. In the operating room, the affected segment was resected, and a transposition of the external carotid artery to the internal carotid artery was performed. Workup of penetrating neck trauma and management options for internal carotid artery pseudoaneurysms in a pediatric patient are discussed.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Feliciano D.V.
        Management of penetrating injuries to carotid artery.
        World J Surg. 2001; 25: 1028-1035
        • Tisherman S.A.
        • Bokhari F.
        • Collier B.
        • et al.
        Clinical practice guideline: penetrating zone II neck trauma.
        J Trauma. 2008; 64: 1392-1405
        • Munera F.
        • Soto J.A.
        • Palacio D.M.
        • et al.
        Penetrating neck injuries: helical CT angiography for initial evaluation.
        Radiology. 2002; 224: 366-372
        • Inaba K.
        • Munera F.
        • McKenney M.
        • et al.
        Prospective evaluation of screening multislice helical computed tomographic angiography in the initial evaluation of penetrating neck injuries.
        J Trauma. 2006; 61: 144-149
        • Rostomily R.C.
        • Newell D.W.
        • Grady M.S.
        • et al.
        Gunshot wounds of the internal carotid artery at the skull base: management with vein bypass grafts and a review of the literature.
        J Trauma. 1997; 42: 123-132
        • ul Haq T.
        • Yaqoob J.
        • Munir K.
        • et al.
        Endovascular-covered stent treatment of posttraumatic cervical carotid artery pseudoaneurysms.
        Australas Radiol. 2004; 48: 220-223
        • Mussa F.F.
        • Towfigh S.
        • Rowe V.L.
        • et al.
        Current trends in the management of iatrogenic cervical carotid artery injuries.
        Vasc Endovascular Surg. 2006; 40: 354-361
        • Kent K.C.
        • McArdle C.R.
        • Kennedy B.
        • et al.
        A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture.
        J Vasc Surg. 1993; 17 ([discussion 31-3]): 125-131
        • Cothren C.C.
        • Moore E.E.
        • Biffl W.L.
        • et al.
        Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate.
        Arch Surg. 2004; 139 ([discussion 5-6]): 540-545
        • Yadav J.S.
        • Wholey M.H.
        • Kuntz R.E.
        • et al.
        Protected carotid-artery stenting versus endarterectomy in high-risk patients.
        N Engl J Med. 2004; 351: 1493-1501
        • Edwards N.M.
        • Fabian T.C.
        • Claridge J.A.
        • et al.
        Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from longterm followup.
        J Am Coll Surg. 2007; 204 ([discussion 14-5]): 1007-1013
        • Cothren C.C.
        • Moore E.E.
        • Ray Jr, C.E.
        • et al.
        Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits.
        Arch Surg. 2005; 140 ([discussion 5-6]): 480-485
        • Reichard K.W.
        • Reyes H.M.
        Vascular trauma and reconstructive approaches.
        Semin Pediatr Surg. 1994; 3: 124-132
        • Stanley J.C.
        • Zelenock G.B.
        • Messina L.M.
        • et al.
        Pediatric renovascular hypertension: a thirty-year experience of operative treatment.
        J Vasc Surg. 1995; 21 ([discussion 26-7]): 212-226
        • Huang Y.
        • Duncan A.A.
        • McKusick M.A.
        • et al.
        Renal artery intervention in pediatric and adolescent patients: a 20-year experience.
        Vasc Endovascular Surg. 2007; 41: 490-499
        • Stanley J.C.
        • Ernst C.B.
        • Fry W.J.
        Fate of 100 aortorenal vein grafts: characteristics of late graft expansion, aneurysmal dilatation, and stenosis.
        Surgery. 1973; 74: 931-944