Technical Options for the Surgical Management of Extracranial Carotid Artery Aneurysms

Abstract

Three cases of extracranial carotid artery (ECA) aneurysm were treated with various surgical options. Two female patients (74 and 37-year-old women) presented with pulsatile masses in their necks, which were confirmed as ECA aneurysms. Another 65-year-old woman presented with a calcified mass in her neck caused by an ECA aneurysm. The first case was treated with aneurysmorrhaphy with primary closure, the second with replacement of the involved site with vascular prosthesis, and the third with a high flow bypass with proximal ligation of the internal carotid artery. All three different surgical techniques were successful. ECA aneurysms are rare and require careful selection of the surgical method according to etiology, shape, and location of the ECA aneurysm. Proficiency in various vascular reconstruction techniques is a desirable prerequisite for the surgeon in-charge.

Open surgery versus endovascular approach in treatment of extracranial carotid artery aneurysms

“…Although they are usually asymptomatic, 50% of untreated ECCAs lead to cerebral thromboembolic events as a potential origin of emboli. 5,6 In addition, local nerve compression, rupture, and bleeding are emerging symptoms with the growth of aneurysms. Therefore, surgical intervention is recommended for ECCAs to minimize these potential complications.…”

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note

“…[ 6 , 15 ] In addition, a high mortality rate has also been reported with conservative treatment. [ 21 , 24 ] Therefore, surgical treatment is often required in these cases. The basic strategy for the surgical treatment of EICA is aneurysm resection and revascularization of the ICA.…”

“…Several procedures for the treatment of EICA have been reported, such as direct suture of the defect after aneurysm resection, direct end-to-end anastomosis of the ICA or CCA after aneurysm resection, autologous or artificial vascular graft after aneurysm resection, or ligation of aneurysms under combined bypass. [ 2 , 8 , 21 ] Direct suturing of the defect is an option after aneurysm resection when a sufficient normal carotid artery wall remains. [ 21 ] This method has the advantage of being able to suture the residual wall after aneurysm resection without any additional antiplatelet therapy.…”

“…[ 2 , 8 , 21 ] Direct suturing of the defect is an option after aneurysm resection when a sufficient normal carotid artery wall remains. [ 21 ] This method has the advantage of being able to suture the residual wall after aneurysm resection without any additional antiplatelet therapy. The disadvantage of this method is the risk of vessel narrowing due to the suturing.…”

“…Conservative treatment has a high mortality rate (60–70%),[ 21 , 24 ] and either endovascular or surgical treatment are viable modalities, with open surgery remaining advantageous in patients with atherosclerosis. [ 15 ] Endovascular treatment is the method of choice for EICA of traumatic origin.…”