Traumatic Pseudoaneurism of the Vertebral and Right Common Carotid Artery Caused by Rare Water Event

Introduction: The pseudoaneurysm of the common carotid artery represents a rare but highly severe clinical entity, particularly when secondary to hydraulic trauma, defined as damage resulting from the impact of high-pressure water, such as that from industrial hoses. This type of trauma is uncommon and often underestimated in its potential to cause significant vascular injuries, including those to vital structures in the neck. Clinical Case: Forty-one-year-old female patient with no significant medical history who 3 weeks ago suffered a closed hydraulic trauma in the right cervical region (high-pressure water coming out of a hose while she was washing her car). A color and spectral Doppler ultrasound of the neck vessels was performed with a high-frequency linear transducer in B mode, which reported: on the right side: pseudo aneurysmal image with a path to the vertebral artery measuring 27 x 23 mm, with Yin-Yang sign on Doppler. A diagnosis of a pseudoaneurysm with arteriovenous fistula (towards the right internal jugular vein) of the right vertebral artery was made. After an adequate anatomical evaluation and surgical planning, an endovascular treatment was decided to be performed. Conclusion: The management of common carotid and vertebral artery pseudoaneurysms secondary to hydraulic trauma involves a nuanced approach, integrating advanced diagnostic imaging and tailored treatment strategies. Both open surgical and endovascular approaches have their respective advantages and limitations. Early recognition, appropriate intervention, and rigorous follow-up are essential to optimize patient outcomes and mitigate risks associated with this challenging condition.