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Published on: July 9, 2020
[A complex form of internal carotid artery fibrodysplasia. Surgical management]
Orlanda Castelbranco1, Madalena Romero, Carlos Martins
1Clínica Universitária de Cirurgia Vascular, Hospital de Santa Maria, Lisboa, Portugal.
Insights
A 46-year-old female with transient ischemic attacks was diagnosed with carotid artery dissection and fibrodysplasia. Surgical intervention with saphenous vein graft led to a successful, asymptomatic recovery.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- Transient ischemic attacks (TIAs) necessitate thorough investigation of cerebrovascular pathologies.
- Carotid artery diseases, including dissection and fibrodysplasia, are significant causes of ischemic events.
Observation:
- A 46-year-old female presented with TIAs, revealing right internal carotid artery dissection and occlusion.
- Left internal carotid artery showed a complex lesion with microaneurysms, indicative of fibrodysplasia.
Findings:
- Endovascular treatment was deemed unsuitable due to complex arterial anatomy.
- Surgical excision and saphenous vein autograft replacement of the affected carotid artery segment were performed.
Implications:
- The case highlights surgical management for complex carotid artery disease when endovascular options are limited.
- Successful surgical repair resulted in asymptomatic recovery and excellent graft function, demonstrating a viable treatment pathway.
Abstract:
The clinical case of a 46 years old female is reported , admitted with the diagnosis of cerebral transient ischemic attacks, and subjected to an extensive evaluation. Conventional angiography disclosed the diagnosis of dissection and complete occlusion of the right internal carotid artery and a complex angulated lesion, with microaneurisms, of the middle third of the left internal carotid artery, compatible with the diagnosis of arterial fibrodysplasia. Due to the anatomy of the lesion, an endovascular procedure was judged inapropriate and the patient underwent an excisional surgery, followed by replacement with autologous saphenous vein. The operation and the post operative course were uneventfull and the patient was discharged asymptomatic. One month later she was found in pretty good condition and an echodoppler revealed the graft working in excellent condition. The main aspects of this peculiar pathologic entity are subjected to analysis and discussion.
