[Aneurysms of the carotid arteries]

The aim of the paper is the presentation of the treatment of aneurysms of the extracranial carotid artery and review of literature. Aneurysms of extracranial carotid arteries (common carotid artery, external carotid artery and cervical part of the internal carotid artery) are very rate [1, 2]. In 1979 McCollum from the Baylor University (Houston, Texas) reported 37 cases over a 21-year period [3]. Moreau from France reported 38 cases over a 24-year period [4]. Mayo clinic experience includes 25 cases in the 40-year period [5]. According to Schechter 835 extracranial carotid artery aneurysms were reported in literature until 1977. These and the other aneurysms of the extracranial carotid artery can be partially or completely thrombosed, can cause distal embolization, or compression of adjacent structures, and can be ruptured [4, 9]. Therefore, the mortality rate in non operated patients with carotid artery aneurysm is 70% [10]. Over the period from January 1, 1985 to December 31, 1996 at the Centre of Vascular Surgery within the Institute of Cardiovascular Diseases of the Serbian Clinical Centre in Belgrade, 12 patients with 13 extracranial carotid artery aneurysms were treated. Nine of them (75%) were males and 3 (25%) females, average age 58.22 (21-82) years. There were two traumatic (gunshot wounds) and one anastomotic (after carotid subclavian bypass with PTFE graft) pseudoaneurysms, and 10 true atherosclerotic aneurysm. Three (23%) aneurysms were on the common and 9 (77%) on the cervical part of the internal carotid artery. Two (15%) aneurysms were in the form of asymptomatic pulsatile neck mass, 7 (54%) with CVI or TIA, three (23%) with compression of the cranial nerves and one (8%) was ruptured. Twelve (92%) patients were treated surgically, while one asymptomatic aneurysm in a 82-year old female patient was not operated due to high risk. The intraoperative findings revealed one complete and 11 partial thromboses of the aneurysmal sac. In 3 patients with fusiform aneurysms, thrombectomy and aneurysmorrhaphy were performed. One traumatic pseudoaneurysm was treated with aneurysmectomy and lateral suture of the artery. In 3 patients aneurysmectomy and end to end anastomosis were done, while in three aneurysmectomy and saphenous vein graft interposition. In case of ruptured aneurysm of the internal carotid artery aneurysmetomy and arterial ligature were carried out, while in case of anastomotic pseudoaneurysm after carotid subclavian bypass, aneurysmectomy and new carotid subclavian bypass with PTFE graft, were performed. During the study no intrahospital mortality was recorded. One patient died 5 years after the operation due to myocardial infarction. The mean follow-up period was 4 years and 2 months (6 months to 11 years). The early and late potency rates were 100%. Two (17%) CVI and two transient cranial nerve paresies were noticed immediately after the operation. In literature male/female ration in patients with extracranial carotid artery aneurysms is 2:1 [2, 4, 7], but in our study it was 5:1. One (10%) of our patients had a bilateral carotid artery aneurysm. According to literature data the incidence of bilateral localization of extracranial carotid artery aneurysms with atherosclerotic origin is 21% [1]. Of 12 surgically treated aneurysms in our study, 9 were of atherosclerotic origin, two were traumatic and one anastomotic pseudoaneurysms. Today, most of true extracranial carotid artery aneurysms are of atherosclerotic origin [7, 20-25]. However, true extracranial carotid artery aneurysms can be developed due to: infection of the arterial wall (mycotic forms) [26-37]; nonspecific [23] or irradiation arteritis [38], fibromuscular dysplasia [4, 8, 15, 16, 39]. The most frequent types of false extracranial carotid artery aneurysms are traumatic pseudoaneurysms [32, 50-54] and anastomotic pseudoaneurysms [53, 59, 60]. There are also dissecting extracranial carotid artery aneurysms developed after isolated spontaneous d