Elongation of the internal carotid artery and abdominal aortic aneurysm: is there a relationship?
BACKGROUND
This study was undertaken to analyze whether there is a relationship between the elongation of the internal carotid artery (e-ICA) and abdominal aortic aneurysm (AAA).


METHODS
Forty-three patients had concomitant evidence of an asymptomatic AAA and e-ICA: all of these patients underwent surgical AAA repair, while 25 (58.1%) also underwent surgical e-ICA correction. The 43 patients were compared with a control group of 141 e-ICA subjects with no AAA as regards to age, gender, risk factors and associated diseases. An operative specimen of the aneurysmal wall was obtained in 32 instances (74.2%); an operative specimen of the carotid wall was obtained in 100% of operations.


RESULTS
The overall perioperative mortality rate was 0%. Patency of the revascularized ICA was assured in 100% of cases. The perioperative stroke risk rate was 0%. The perioperative morbidity rate for abdominal surgery was 6.9% (3/43). There were three late deaths: one patient died from a major stroke due to occlusion of the unoperated e-ICA. Degenerative dysplastic changes were observed in the tunica media in all carotid specimens; non-obstructive atherosclerotic intimal lesions were superimposed in a few cases. Histological features of "classic" AAA, i.e. thinning of the tunica media underlying the atherosclerotic plaque, were discovered in all but five aortic wall specimens.


CONCLUSIONS
The association between e-ICA and AAA is stronger than one would expect from atherosclerosis alone and should not be ignored. A primary arterial disorder of the tunica media seems to lie at the basis of both conditions, so patients with e-ICA should be investigated and followed up for any occurrence of AAA and, vice versa, patients with AAA should be investigated for any presence of e-ICA. On the basis of the results obtained, surgical repair of both conditions is recommended in selected patients.
Ballotta
E
E
Vascular Surgery Section, 1st Institute of General Surgery, University of Padua, School of Medicine, Italy.
Da Giau
G
G
Bottio
T
T
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology; D005260:Female; D005352:Fibromuscular Dysplasia / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017540:Tunica Media / Q000473:pathology