Extracranial Carotid Artery Aneurysms: 20-Year Experience of Surgical Management

Keywords: diagnosis, resection of aneurysm, arterial reconstruction, carotid endarterectomy, endovascular treatment, complications

Abstract

Extracranial carotid artery aneurysm (ECAA) is a rare vascularpathology with reported incidence of 0.2-5.0% of all carotid artery surgical interventions. Most of ECAAs remain clinically asymptomatic, however, they can manifest in neurological symptoms as transient ischemic attack or stroke. The presence of a pulsating formation, swallowing disorders, signs of compression of cranial nerves may beindicative of the aneurysm growth, which is associated with higher risk of thromboembolic complications and less oftenwith rupture. Surgical treatment is a method of choice in symptomatic patients or in cases of the aneurysm growth and includes resection with arterial reconstruction, ligation of the artery or endovascular intervention.

The aim. To improve the results of surgical treatment of ECAAs.

Materials and methods. The results of clinical examination, laboratory, instrumental, intraoperative observations were analyzed in 39 patients (35 [89.7%] men and 4 [10.3%] women) with 44 ECAAs, who were admitted to the Vascular Surgery Department of Lviv Regional Clinical Hospital for the period from 2003 to 2022. To conϐirm the diagnosis of ECAA, preoperative instrumental examination included duplex ultrasonography and multispiral computed tomography angiography.

Results. Etiological causes of ECAAs included: atherosclerosis (79.5%),ϐibromuscular dysplasia (7.7%), trauma (5.1%), previous operations in the neck region (5.1%) and infection (2.6%). The justiϐication of the choice of surgical tactics depended on the localization of aneurysm, concomitant carotid occlusive disease or pathological deviation of carotid arteries. Early results of surgical treatment were evaluated up to 30 days of the postoperative period. The postoperative complications included: transient ischemic attack in 1 (2.6%), ischemic stroke in 2 (5.1%), cranial nerve damages in 4 (10.3%), thrombosis of arterial reconstruction in 2 (5.1%), hematoma of postoperative wound in 4 (10.3%), infection of postoperative wound in 1 (2.6%) cases. Postoperative mortality was 2.6%.

Conclusion. ECAA is a rare clinical disease that requires an active surgical approach to reduce the risk of ischemic stroke. Reconstructive surgery of ECAAs is a highly effective method of treatment that allows to achieve satisfactory results and prevent the development of severe complications.

References

  1. Martins de Souza N, Vikatmaa P, Tulamo R, Venermo M. Etiology and treatment patterns of ruptured extracranial carotid artery aneurysm. J Vasc Surg. 2021;74(6):2097-103.e7. https://doi.org/10.1016/j.jvs.2021.06.023
  2. Sharma RK, Asiri AM, Yamada Y, Kawase T, Kato Y. Extracranial Internal Carotid Artery Aneurysm – Challenges in the Management: A Case Report and Review Literature. Asian J Neurosurg. 2019;14(3):970-4. https://doi.org/10.4103/ajns.AJNS_292_18
  3. Kraemer CJK, Zhou W. Carotid Aneurysm Review. Int J Angiol. 2019;28(01):17-9. https://doi.org/10.1055/s-0039-1677675
  4. Attigah N, Külkens S, Zausig N, Hansmann J, Ringleb P, Hakimi M, et al. Surgical Therapy of Extracranial Carotid Artery Aneurysms: Long-Term Results over a 24-Year Period. Eur J Vasc Endovasc Surg. 2009;37(2):127-33. https://doi.org/10.1016/j.ejvs.2008.10.020
  5. de Jong KP, Zondervan PE, van Urk H. Extracranial carotid artery aneurysms. Eur J Vasc Surg. 1989;3(6):557-62. https://doi.org/10.1016/s0950-821x(89)80132-x
  6. Pulli R, Dorigo W, Alessi Innocenti A, Pratesi G, Fargion A,Pratesi C. A 20-year Experience with Surgical Management of True and False Internal Carotid Artery Aneurysms. Eur J Vasc Endovasc Surg. 2013;45(1):1-6. https://doi.org/10.1016/j.ejvs.2012.10.011
  7. Chen Z, Chen L, Zhang J, Chen Y, Liu C, Diao Y, et al. Management of Extracranial Carotid Artery Aneurysms: A 6-Year Case Series. Med Sci Monit. 2019;25:4933-40. https://doi.org/10.12659/MSM.914374
  8. Ni L, Weng H, Pu Z, Zheng Y, Liu B, Ye W, et al. Open surgery versus endovascular approach in treatment of extracranial carotid artery aneurysms. J Vasc Surg. 2018;67(5):1429-37. https://doi.org/10.1016/j.jvs.2017.08.093
  9. Welleweerd JC, den Ruijter HM, Nelissen BG, Bots ML, Kappelle LJ, Rinkel GJ, et al. Management of Extracranial Carotid Artery Aneurysm. Eur J Vasc Endovasc Surg. 2015;50(2):141-7. https://doi.org/10.1016/j.ejvs.2015.05.002
  10. Galyfos G, Eleftheriou M, Theodoropoulos C, Vouros D, Georgiou K, Kimpizi D, et al. Open versus endovascular repair for extracranial carotid aneurysms. J Vasc Surg. 2021;74(3):1017-23.e5. https://doi.org/10.1016/j.jvs.2021.04.038
  11. Xue S, Tang X, Zhao G, Tang H, Shen Y, Yang EY, et al. Contemporary Outcomes of Open and Endovascular Intervention for Extracranial Carotid Artery Aneurysms: A Single Centre Experience. Eur J Vasc Endovasc Surg. 2020;60(3):347-54. https://doi.org/10.1016/j.ejvs.2020.04.042
  12. Fankhauser GT, Stone WM, Fowl RJ, O’Donnell ME, Bower TC, Meyer FB, et al. Surgical and medical management of extracranial carotid artery aneurysms. J Vasc Surg. 2015;61(2):389-93. https://doi.org/10.1016/j.jvs.2014.07.092
  13. Giannopoulos S, Trinidad E, Aronow H, Soukas P, Armstrong EJ. Εndovascular Repair of Extracranial Carotid Artery Aneurysms: A Systematic Review. Vasc Endovascular Surg. 2020;54(3):254-63. https://doi.org/10.1177/1538574419895383
  14. Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, et al. Editor’s Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):3-81. https://doi.org/10.1016/j.ejvs.2017.06.021
Published
2022-12-26
How to Cite
Kobza, I. I., Mota, Y. S., & Kobza, T. I. (2022). Extracranial Carotid Artery Aneurysms: 20-Year Experience of Surgical Management. Ukrainian Journal of Cardiovascular Surgery, 30(4), 81-87. https://doi.org/10.30702/ujcvs/22.30(04)/KM052-8187
Section
PERIPHERAL VASCULAR DISEASE PATHOLOGY