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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1999 June;40(3):429-33

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Double layered autogenous vein graft patch reconstruction of the common carotid-internal jugular fistula caused by gunshot wound

Kaklikkaya I., Ozcan F., Kutlu N.*

From the Department of Thoracic and Cardiovascular Surgery * Department of Plastic and Reconstructive Surgery Karadeniz Technical University, Faculty of Medicine Trabzon, Turkey


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Hereby ­we present a ­case ­with a ­common ­carotid-­internal jug­ular fis­tula ­caused by gun­shot ­wound. The ­patient was a 32-­year old ­male who had an ­entrance ­hole of a ­bullet on his ­right ante­rior cer­vical ­area, at the C4 ­level ­with a ­hematoma sur­rounding it. The ­exit ­hole ­could be ­detected at the sub­lin­gual ­area. By pal­pa­tion a ­thrill and on aus­cul­ta­tion a ­souffle was ­noted. Nei­ther crep­i­ta­tion, nor any neu­ro­logic def­icit or any ­symptom of ­Horner’s syn­drome was ­present. The emer­gency dig­ital sub­trac­tion angio­graphy (DSA) ­showed a fis­tul­isa­tion to ­internal jug­ular ­vein (IJV) approx­i­mately 0.5 cm ­below the ­common ­carotid ­artery (CCA) bifur­ca­tion ­level. ­During the oper­a­tion a ­hematoma and a ­false aneu­rysm was ­observed on the CCA. ­Also, prox­i­mally to the bifur­ca­tion, a com­mu­ni­ca­tion of CCA ­with IJV was ­noted. The ­wall of the JJV was ­rather ­thinned and the ­size of the ­vessel had con­sid­er­ably ­enlarged. Fol­lowing the evac­u­a­tion of the ­hematoma and debride­ment, the inte­gra­tion of the ­artery was ­achieved by ­placing a ­double ­layered autog­e­nous ­vein ­graft ­patch ­over the 0.5×1.5 cm ­defect. The 0.3×1.5 cm ­defect lat­er­ally ­over the IJV was pri­marily ­sutured. The ­patient was dis­charged on the ­fifth day. The con­trol DSA ­taken on the ­twelfth day ­showed a per­fect inte­gra­tion of the ves­sels. We con­sid­ered the ­case notice­able due to its ­rather ­rare inci­dence and the ­double ­layered ­autogen ­vein ­patch ­graft recon­struc­tion.

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