We report a case of true aneurysm of the left common carotid artery in a 34-year-old woman. It was successfully treated with excision and autogenous saphenous graft replacement using hyperoxygenation and internal shunt. Alternate methods of restoration of continuity that were considered are depicted, eg, creation of a permanent shunt between both external carotid arteries, and venous bypass shunt between the proximal carotid and the external carotid arteries. The interesting feature in this case was that microscopic examination of the removed specimen showed suppurative inflammation of the aneurysm. There was no history of systemic or local infection and no organisms could be detected.