Open Access

LETTER

Carotid Artery Pseudoaneurysm in a Pediatric Patient Following ECMO: Management with Carotid Artery Ligation and Pseudoaneurysm Resection under Balloon Occlusion-Guided DSA

Yaqi Zhang^1,#, Liang Hu^1,#, Yuxi Zhang¹, Bo Qian¹, Jirong Qi^1,2, Wei Peng^1,2,*

1 Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, 210008, China
2 Clinical Teaching Hospital of Medical School, Nanjing Children’s Hospital, Nanjing University, Nanjing, 210093, China

* Corresponding Author: Wei Peng. Email:
# These authors contributed equally to the present study and should be regarded as joint first authors

Congenital Heart Disease 2025, 20(1), 55-60. https://doi.org/10.32604/chd.2025.063072

Received 04 January 2025; Accepted 06 March 2025; Issue published 18 March 2025

Abstract

Background: Carotid artery pseudoaneurysm in children is rare; typically caused by trauma; surgical interventions and infection. These aneurysms can lead to significant neurological and vascular risks; and their management remains challenging. While endovascular therapy has become the standard for giant pseudoaneurysms in adults; its use in children is limited. No established guidelines or long-term safety data exist for pediatric endovascular treatment. We present a child who developed a carotid artery pseudoaneurysm after venoarterial extracorporeal membrane oxygenation (VA-ECMO) support and heart transplantation; highlighting the management strategies and outcomes. Case Description: A 4-year-old boy with dilated cardiomyopathy was admitted for congestive heart failure and subsequently required VA-ECMO support due to worsening hemodynamics. After heart transplantation; the patient developed a persistent hoarseness and a rapidly enlarging neck mass. Imaging confirmed the presence of a giant carotid artery pseudoaneurysm. Balloon occlusion-guided digital subtraction angiography (DSA) revealed adequate collateral circulation; allowing successful carotid artery ligation and pseudoaneurysm resection. Postoperative recovery was uneventful; with no neurological deficits or complications; and regular follow-up confirmed no further adverse sequelae. Conclusions: Management of carotid artery pseudoaneurysms in pediatric patients remains challenging. Under the guidance of DSA and with the assistance of balloon occlusion; precise aneurysm resection and vascular reconstruction can be achieved. In the event that vascular conditions limit the success of the repair; the balloon’s ability to occlude the parent artery and supplying vessels can safely facilitate the ligation of the parent artery of the aneurysm.

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Supplementary Material

Supplementary Material File

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