Bilateral Extracranial Carotid Artery Aneurysms Treated by Staged Surgical Repair

Abstract

IntroductionBilateral extracranial carotid artery aneurysms (ECAAs) are very rare. The case of a patient with bilateral ECAA who underwent staged surgical repair is reported.ReportA 35 year old man was referred with a slow growing pulsatile neck mass causing mild discomfort. Computed tomography and duplex ultrasound showed a right ECAA, with a 3.0 cm diameter 5 cm long true aneurysm, and a left ECAA, with 2.1 cm diameter 4.5 cm long true aneurysm. In two stages, both aneurysms were excised and bypassed with an interposition graft using saphenous vein.DiscussionECAAs are rare with an incidence of about 4% of all peripheral aneurysms. Selection of treatment options is largely dependent on the aneurysm anatomy, including size and length. During open repair, it is important to avoid nerve injury.

Endovascular management of saccular extracranial internal carotid artery aneurysm using transcervical carotid approach and flow reversal

“…Selection of treatment options largely depends on aneurysm anatomy, including size and length 14 . Evidence about best treatment is scarce owing to the rarity of disease and publication bias 15 . Treatment of the extracranial carotid artery aneurysm is necessary in most cases because of the high risk of fatal complications related to embolization and local compression 15 .…”

“…Evidence about best treatment is scarce owing to the rarity of disease and publication bias 15 . Treatment of the extracranial carotid artery aneurysm is necessary in most cases because of the high risk of fatal complications related to embolization and local compression 15 . Conservative management is associated with a 71% mortality rate, 4 and ligation carries catastrophic consequences.…”

Treatment of Extracranial Carotid Artery Aneurysms: What is Known and What is Unknown?

“…Park and Kim report on a patient with bilateral extracranial carotid artery aneurysms (ECAA) presenting with mild loco-cervical discomfort but no cerebrovascular sequelae. 1 The ECAA diameter was 2.1 cm on one side and 3 cm on the contralateral side but lengthy over 5 cm. The focus of both the case report and the related commentary was on the surgical intervention performed, but the most important question is if this patient needed intervention at all.…”

Carotid Duplex Study of the Left External Carotid Artery Transposition for the Repair of the Left Internal Carotid Artery Aneurysm

“…There are a few reported case studies of a pseudoaneurysm of an internal carotid artery after a procedure of endarterectomy, but a true extracranial internal carotid artery aneurysm, like in this case study, is very rare. [1][2][3][4] There are several procedures discussed in publications for a repair of an internal carotid artery aneurysm: an end-to-end anastomosis using the same artery for a focal aneurysm, a graft using a vein or a synthetic material for a longer aneurysm, embolization for a saccular aneurysm, an endovascular surgery with a covered stent and coil embolization in the external carotid artery when vessels are vulnerable from chemotherapy, transposition of the distal internal carotid artery onto a branch of the distal external carotid artery, and transposition of the external carotid artery into the internal carotid artery. 1,5,6 This case study discusses a carotid duplex study of the last procedure, transposition of the external carotid artery into the internal carotid artery, with images from computed tomography as the confirmation.…”