Surgical repair of carotid artery aneurysms: a 10-year, single-center experience

The aim of this study was to evaluate the surgical management of carotid artery aneurysms (CAAs) presenting to a tertiary care center over a 10-year period of time.

The medical records of patients undergoing repair of CAA between 1998 and 2008 were reviewed. Demographics, clinical presentation, and operative interventions were recorded. Postoperative outcomes were assessed, and patency and survival rates were calculated using life-table analysis.

Two patients (11%) had a history of neck dissection, one (5%) neck irradiation, and three (16%) a combination of neck dissection and irradiation for cancer. Five (26%) had previous carotid endarterectomy, while three (16%) had prior carotid artery stenting for occlusive disease. Eight (42%) patients presented with neurologic symptoms, all transient in nature. Aneurysms were isolated to the internal carotid artery in eight (42%) cases, the common carotid artery in one (5%) case, and both regions in the remaining 53%. The etiologies of the aneurysms were divided among atherosclerotic aneurysms (36.8%), mycotic pseudoaneurysms (36.8%), and patch aneurysms (26.3%).Twelve (63%) underwent resection and interposition grafting, six underwent aneurysm resection and patch repair, and one (5%) had end-to-end reconstruction. Postoperative complications included one transient ischemic attach (5%), two strokes (10%), and one cranial nerve deficit (5%). Primary patency at 30 months was 90% (standard error [SE] = 0.10), and survival at 48 months was 92% (SE = 0.10). Assisted primary patency was maintained at 90% at 30 months (SE = 0.10).

CAA surgery, while rare, can be performed safely and with durable patency. Future studies will be necessary to assess the efficacy of endovascular therapy for this disease.