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Management of extracranial carotid artery aneurysms: 17 years' experience
1Department of Surgery, The First Teaching Hospital, Shenyang, 110001, China.
Insights
Surgical management of extracranial carotid artery aneurysms using resection and saphenous vein graft reconstruction is effective. An end-to-side anastomosis technique minimizes neurological complications by avoiding a blind-ending carotid stump.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease Management
- Surgical Reconstruction Techniques
Background:
- Extracranial carotid artery aneurysms are rare but can lead to serious complications.
- Management strategies have evolved over time.
- Understanding the outcomes of different surgical approaches is crucial.
Purpose of the Study:
- To review the seventeen-year experience (1980-1996) in managing extracranial carotid artery aneurysms.
- To evaluate the effectiveness and safety of surgical resection and reconstruction.
- To identify factors influencing patient outcomes.
Main Methods:
- A retrospective review of 66 extracranial carotid artery aneurysms in 63 patients.
- Diagnosis confirmed by angiography or duplex ultrasonography.
- Surgical management primarily involved aneurysm resection with saphenous vein graft interposition.
Main Results:
- Operative mortality was 1.5% (one death from sepsis).
- Early neurological complications (hemiparesis) occurred in 6.1% of patients.
- Adopting an end-to-side anastomosis technique eliminated neurological complications in subsequent cases.
Conclusions:
- Resection and reconstruction with autogenous saphenous vein provide successful management for extracranial carotid aneurysms.
- The end-to-side anastomosis technique is superior as it avoids a blind-ending stump, a potential source of emboli.
- This surgical approach offers a safe and effective treatment option for these aneurysms.
Objectives:
a retrospective review of seventeen-year (1980-1996) experience of the management of extracranial carotid artery aneurysms.
Patients And Methods:
sixty-six aneurysms of extracranial carotid artery were seen in 63 patients. The diagnosis was confirmed by angiography in 51 patients and duplex ultrasonography in twelve. Twenty-eight (42%) patients had an atherosclerotic aneurysm, twenty-two (33%) had false aneurysms secondary to trauma, nine were congenital and seven were mycotic. All underwent aneurysm resection with saphenous-vein-graft interposition as the most common means of reconstruction.
Results:
one death occurred due to septicaemia in a diabetic patient with a mycotic aneurysm, giving an operative mortality of 1.5%. One patient had an immediate hemiparesis after carotid artery ligation, and three had a hemiparesis within 48 hours of operation (6.1%). After a change in technique to avoid a residual carotid stump, no further neurological problems were encountered in the following 28 patients.
Conclusion:
extracranial carotid aneurysms may be successfully managed with resection and reconstruction with autogenous saphenous vein. End-to-side anastomosis avoids a blind-ending stump which may be the source of emboli.