Surgical Treatment of Saccular Extracranial Carotid Artery Aneurysm

Extracranial carotid artery aneurysms (ECAAs) are an increase of 50% or more in the diameter of the carotid artery and classified by location. They are rare and most are located in the internal carotid artery or carotid bifurcation. Diagnosis is incidental or by the presentation of a pulsatile neck mass or neurological symptoms. There are no universal recommendations regarding its treatment. Male, 72 years old, with a pulsatile cervical mass on the left. No history of previous trauma. Angioresonance and angiography identified a saccular aneurysm in the carotid bulb, measuring 1 × 0.7 cm. Referred for open surgical treatment, which was performed under general anesthesia and by longitudinal anterior cervicotomy, endoaneurysmorrhaphy, and bovine pericardium patch. There was an uneventful postoperative recovery and hospital discharge on the 3rd postoperative day. ECAAs represent between 0.4% and 1.9% of all peripheral aneurysms. They are more prevalent in men, with an average age at diagnosis of 53 ± 17 years. They can be divided into fusiform or saccular. The most common etiology of ECAA is atherosclerosis (50% of cases). ECAAs can be classified according to Attigah into Types I to V, based on the segment involved. Half of the patients with ECAAs have symptoms at diagnosis. Presentation may include a pulsatile neck mass, cervical discomfort, headache, stroke, or neurological deficits. Although rare, rupture can occur. The indication for correction of ECAAs is based on the risk of cerebral ischemia. Duplex ultrasound is the first option for diagnosis. Angiotomography, angioresonance, and angiography are options as confirmatory examinations. The techniques for repairing ECAAs are endovascular, hybrid or open: stents, embolization, or correction by arterial resection and reconstruction or patch. ECAAs are rare and have potential complications due to cerebral thromboembolism. ECAA repair is possible through open or endovascular techniques.