The surgical management of carotid paragangliomas can be problematic. A multidisciplinary approach was used to include vascular surgery, otolaryngology, and neuroradiology to treat these patients over 9 years. From January 1992 to July 2001, a multidisciplinary team evaluated patients with carotid paragangliomas. Analyzed patient data included age, gender, diagnostic evaluation, tumor size, preoperative tumor embolization, operative exposure, need for extracranial arterial sacrifice/reconstruction, postoperative morbidity including cranial nerve dysfunction, and long-term follow-up. Twenty-five carotid paragangliomas in 20 patients underwent multidisciplinary evaluation and management. Average age was 51 years (range, 28-83 years), and 52% were male. Diagnostic evaluation included computed tomography in 76%, magnetic resonance imaging/magnetic resonance angiography in 52%, catheter angiography in 60%, and duplex ultrasonography in 16%. An extended neck exposure was required in 11 cases (44%), mandibulotomy was used once (4%), and mandibular subluxation was never required. The external carotid artery (ECA) was sacrificed in 8 cases (32%). The carotid bifurcation was resected in 1 patient (4%) requiring interposition reconstruction of the internal carotid artery. Preoperative tumor embolization was performed for 13 tumors (52%). Operative blood loss for patients undergoing preoperative embolization (Group I) was comparable to the nonembolized group (group II): group I lost 365 +/-180 mL versus 360 +/- 101 mL for group II (P = .48). This occurred despite larger tumors (group I - 4.2 cm versus group II - 2.1 cm, P = .03) and a higher mean Shamblin class (group I - 2.5 versus group II - 1.45, P = .001) for group I. There were no perioperative mortalities. Transient cranial nerve dysfunction occurred in 13 CBTs (52%), 2 (8%) of which remained present after 4 months. Patients with carotid paragangliomas benefit from a multidisciplinary team approach. Neuroradiology has been used for selective preoperative embolization, which has decreased estimated blood loss during excision of larger complex tumors. A combined surgical team of otolaryngology and vascular surgery provides for exposure of the distal internal carotid artery as high as the skull base, limited permanent cranial nerve dysfunction, and selective early division and excision of the external carotid artery for complete tumor resection.

Blunt vascular trauma is rare as compared with penetrating vascular trauma. The incidence of iliac artery injury has been reported as low as 0.4 per cent of total arterial trauma. Iliac artery injury in blunt trauma is rare because of its anatomic location and protection by the pelvis. This article presents a case of external iliac artery injury secondary to blunt trauma. A deceleration-type mechanism is suggested that results in the production of an intimal flap and later vessel thrombosis. We discuss the clinical details of presentation and angiographic diagnosis as well as treatment options.

ENDOVASCULAR stents have become a commonly employed tool in the treatment of vascular disease. Possible complications associated with the use of stents include hemorrhage and/or hematoma, acute or chronic reocclusion, vessel dissection or rupture, and embolic phenomenon. Endovascular stents have been shown in animal models to have the potential for infection ( 1 Thibodeaux LC James KV Lohr JM Welling RE Roberts WH Infection of endovascular stents in a swine model. Am J Surg. 1996; 172: 151-154 Abstract Full Text PDF PubMed Scopus (41) Google Scholar , 2 Hearn AT James KV Lohr JM Thibodeaux LC Roberts WH Welling RE Endovascular stent infection with delayed bacterial challenge. Am J Surg. 1997; 174: 157-159 Abstract Full Text PDF PubMed Scopus (41) Google Scholar ), and in recent years there have been increasing numbers of single case reports in the literature of stent infections in humans. These infections can have the potential to become life threatening ( 3 Therasse E Soulez G Cartier P et al. Infection with fatal outcome after endovascular metallic stent placement. Radiology. 1994; 192: 363-365 PubMed Google Scholar , 4 Gunther HU Strupp G Volmar J von Korn H Bonzel T Stegmann T Coronary stent implantation: infection and abscess with fatal outcome. Z Kardiol. 1993; 82: 521-525 PubMed Google Scholar ). This article describes a report of death secondary to bilateral infected renal artery pseudoaneurysms after placement of bilateral renal artery stents.