Blast injury to carotid artery from contralateral gunshot wound

Blast injury to left carotid artery and repair in the thoracic inlet. The patient had a GSW at the base of the right neck in zone I. Neck exploration demonstrated a blast injury to the left common carotid artery and pseudoaneurysm formation (A). A median sternotomy was required to obtain proximal access and control of the left common carotid artery at its takeoff from the aortic arch. The adventitia overlying the pseudoaneurysm was removed, showing a full-thickness carotid artery defect (B). The injured segment of the carotid artery was resected and mobilized and repaired primarily in an end-to-end fashion (C).