Extracranial internal carotid artery aneurysms: results of a surgical series with long-term follow-up.
OBJECTIVE
The purpose of this study was to analyze mode of presentation, surgical treatment, and early and long-term results of a series of extracranial internal carotid artery aneurysms (EICAA).


METHODS
A retrospective analysis was performed on all cases treated for EICAA in a single institution from March 1974 to March 1995. Patient follow-up was obtained by a surveillance protocol, with duplex scanning performed 3 months after surgery and yearly thereafter.


RESULTS
Twenty-four EICAA in 20 patients were treated over a 21-year period. The cause was fibromuscular dysplasia in 12 cases (50%), nonspecific "atherosclerosis" in nine (37.5%), previous carotid artery surgery in two (8.3%), and trauma in one case (4.1%). Neurologic symptoms were present in a total of nine cases (37.5%) and were hemispheric in seven (29.1%) and nonhemispheric in two (8.3%). Operative techniques were performed with patients receiving general anesthetic and included aneurysm excision with internal carotid artery reanastomosis (8 cases [33.3%]) or reimplantation onto the external carotid artery (1 case [4.1%]); interposition graft (10 cases [41.6%]), 7 veins, 3 polytetrafluoroethylene) or simple aneurysmectomy and closure of the wall defect either with (3 cases [12.5%]) or without (2 cases [8.3%]) a patch. Elective surgery was performed in 22 cases, with a 0% mortality rate and 4.5% stroke rate. Emergency operations were performed in two cases of ruptured aneurysms (one spontaneous and one iatrogenic); one patient (50%) died. Cranial nerve morbidity occurred in five cases (20.8%). Mean follow-up was 96.7 +/- 88.15 months (range 4 to 240 months) and included 2 of 7 (28%) complications in saphenous vein grafts, 1 (4.1%) late transient ischemic attack, and a recurrent aneurysm after 19 years.


CONCLUSIONS
Symptoms and potential complications caused by EICAA suggest a broad surgical indication. EICAA can be treated safely because of the good early and long-term results.
Faggioli
G L
GL
Department of Vascular Surgery, University of Bologna, Italy.
Freyrie
A
A
Stella
A
A
Pedrini
L
L
Gargiulo
M
M
Tarantini
S
S
Ricotta
J J
JJ
D'Addato
M
M
D000368:Aged; D000714:Anastomosis, Surgical; D000768:Anesthesia, General; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001161:Arteriosclerosis / Q000150:complications; D001807:Blood Vessel Prosthesis; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002342:Carotid Artery, External / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology; D003389:Cranial Nerve Diseases / Q000209:etiology; D017558:Elective Surgical Procedures; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011138:Polytetrafluoroethylene; D011159:Population Surveillance; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D015996:Survival Rate; D018616:Ultrasonography, Doppler, Duplex
D011138:Polytetrafluoroethylene