One-Stage Endovascular-to-Open Repair for Traumatic Common Carotid Artery (CCA) Pseudoaneurysm: Expanding the Hybrid Treatment Landscape

We report the case of a 62-year-old male who presented with a gradually enlarging, pulsatile cervical mass four months after sustaining a penetrating neck injury. Imaging revealed a 28 × 20 mm pseudoaneurysm of the left common carotid artery (CCA), located 15 mm proximal to the bifurcation, without evidence of active bleeding. Given the lesion's size, delayed presentation, and proximity to the carotid bifurcation, a single-stage hybrid treatment strategy was pursued. An endovascular covered stent was first deployed to achieve immediate haemodynamic stabilisation and maintain cerebral perfusion. This enabled safe and controlled surgical dissection during the same operative session. Definitive open repair was then performed, including resection of the pseudoaneurysm and interposition of a reversed autologous femoral vein graft between the CCA and the carotid bifurcation. Postoperative imaging confirmed graft patency, and the patient experienced no new neurological deficits. To our knowledge, this represents the first reported case of a traumatic CCA pseudoaneurysm in an adult managed with a single-stage approach in which a temporary endovascular stent was used as a bridge to definitive open reconstruction. This novel strategy highlights the expanding role of hybrid techniques in vascular trauma and underscores the value of surgical versatility in the management of complex arterial injuries.