Suspected carotid stent-graft infection presenting as recurrent

Background: Carotid blowout syndrome (CBS) is a catastrophic complication associated with head-and-neck surgery and other conditions involving exposure or erosion of major cervical vessels. Covered stent-graft placement can provide rapid hemostasis while preserving arterial patency. However, implantation in a contaminated field adjacent to a tracheostoma may predispose patients to devastating device-related infection, particularly in immunocompromised hosts. Case presentation: We report the case of a 35-year-old man with stage IVB thymic carcinoma (T4N2M0) who received induction chemotherapy combined with immunotherapy followed by extended resection, including segmental tracheal resection, right thyroid lobectomy with isthmusectomy, supraclavicular island flap tracheal reconstruction, and tracheostomy. Thirteen days after discharge, he developed massive hemoptysis consistent with CBS and underwent emergency neck exploration, angiography, and placement of covered stent grafts in the right common carotid and right subclavian arteries. During the subsequent course, he developed recurrent fever, and repeated blood cultures grew Conclusions: This case suggests that covered stent placement in a contaminated head-and-neck field should be undertaken with great caution, as subsequent bacterial colonization or stent-graft infection may occur and may further lead to recurrent or even catastrophic hemorrhage. When stent implantation is unavoidable, early multidisciplinary evaluation is essential, and every effort should be made to prevent wound infection, bacterial colonization of the device, and related bleeding complications.