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Objectives
Atherosclerosis is the most common etiologic factor for extracranial carotid artery aneurysm in adults, while in childhood, connective tissue diseases, peritonsillar abscess and infections are the most common. Congenital carotid artery aneurysms are rarely reported in the literature.
Methods
We present a 10-year-old girl with congenital extracranial left internal carotid artery aneurysm and the treatment management.
Results
Computed tomography angiography at six months showed that internal carotid artery segments were normal. There was no obstruction or aneurysm recurrence.
Conclusions
Although extracranial carotid artery aneurysms are rare, they can cause complications such as rupture and thromboembolism with high mortality and morbidity. Therefore, the treatment of extracranial carotid artery aneurysms is recommended.
Extracranial carotid artery aneurysms (CAAs) are rare, but confer risk of stroke, rupture and local symptoms. Few cases have been reported even from large centres, thus the knowledge of the disease is limited. Our purpose was to study epidemiology, surgical treatment and outcomes of CAAs in a nationwide setting utilizing Swedvasc registry data.
Data on all surgical interventions for CAAs from January 1997 to December 2011 were retrieved from the Swedvasc. Additional clinical information was collected from the hospital records.
48 CAAs were identified. Aetiology was atherosclerosis in thirty-four, infection in two and pseudoaneurysm in twelve cases. Most common presentation was a pulsatile mass with or without local symptoms. Aneurysms isolated to the internal carotid artery predominated. Resection with end-to-end anastomosis was the most common technique. Amongst true aneurysms, 24% had a known synchronous aneurysm elsewhere. Stroke-free survival (n=48) was 90% after thirty days and 85% after one year. 12,5% suffered permanent cranial nerve injury and 33% suffered any complication.
CAAs are rare entities in vascular surgery. In terms of stroke-free survival, our national results approaches reports from large volume centres. The relatively high risk for permanent cranial nerve injury advocates caution when operating on CAAs.
Background and Purpose: Aneurysms of the extracranial carotid artery (ECA) are rare. Large single-institution series are seldom reported and usually are not aneurysm type-specific. Thus, information about immediate and long-term results of surgical therapy is sparse. This review was conducted to elucidate etiology, presentation, and treatment for ECA aneurysms.
We retrospectively reviewed the case records of the Texas Heart Institute/St Luke's Episcopal Hospital, Houston, and found 67 cases of ECA aneurysms treated surgically (the largest series to date) between 1960 and 1995: 38 pseudoaneurysms after previous carotid surgery and 29 atherosclerotic or traumatic aneurysms. All aneurysms were surgically explored, and all were repaired except two: a traumatic distal internal carotid artery aneurysm and an infected pseudoaneurysm in which the carotid artery was ligated.
Four deaths (three fatal strokes and one myocardial infarction) and two nonfatal strokes were directly attributed to a repaired ECA aneurysm (overall mortality/major stroke incidence, 9%); there was one minor stroke (incidence, 1.5%). The incidence of cranial nerve injury was 6% (four cases). During long-term follow-up (1.5 months-30 years; mean, 5.9 years), 19 patients died, mainly of cardiac causes (11 myocardial infarctions).
The potential risks of cerebral ischemia and rupture as well as the satisfactory long-term results achieved with surgery strongly argue in favor of surgical treatment of ECA aneurysms.
The aim of this study was to describe the surgical technique employed and our results in the treatment of saccular aneurysms of the internal carotid artery at the extracranial level. We describe 3 cases of patients with saccular aneurysms of the extracranial internal carotid who underwent surgery at our unit within the last 3 years. We report on indications for treatment, surgical technique and results in terms of morbidity-mortality and also review the pertinent literature. Surgical treatment was indicated on the grounds of the patients being symptomatic: 2 had a history of cerebral ischemia, and 1 showed local compression symptoms. The surgical approach was presternocleidomastoid cervicotomy extended distally, and in 2 patients was accompanied by nasotracheal intubation to achieve adequate exposure. In 2 cases, we performed an aneurysmectomy with end-to-end anastomosis. In the third patient, the aneurysm neck was ligated from within the sac followed by aneurysmectomy. There was no mortality or neurological morbidity (local or general). The patients remain free from neurological symptoms with a patent carotid axis. Our clinical experience suggests that, despite the anatomically unfavorable location of this type of aneurysm and the greater complexity of the surgical technique, this patient group can be effectively treated. The frequent presence of an elongated carotid axis and an aneurysmal neck means the surgeon can easily restore arterial continuity by direct procedures.