Differentiated treatment of aneurysms of the extracranial carotid artery.
OBJECTIVE
Aim of the study is to illustrate current therapeutic options for aneurysms of the extracranial carotid artery.


METHODS
From 1987 until 2003 14 patients (average age: 60 years) with an aneurysm of the extracranial internal carotid artery were treated. The aneurysm diameter ranged from 5 mm to 60 mm. Thirteen patients underwent elective surgery. One patient was operated upon because of acute severe cervical bleeding.


RESULTS
Most patients (10/14) presented with an asymptomatic pulsatile cervical mass. The aneurysm was diagnosed 3 times during carotid angiography. The underlying etiology was atherosclerosis in 10 patients. In 3 cases the aneurysm was considered mycotic. Ten aneurysms were localized at the carotid bifurcation whereas 2 each were found in the retrostyloideal region and at the base of the skull. Vascular continuity could be restored in 10 patients while in 3 the carotid artery had to be occluded (twice surgically and once radiologically). The final patient underwent stent insertion for post-traumatic distal aneurysm. In 5 patients perioperative neurological complications were noted which persisted in a single patient (dysphagia due to a lesion of the hypoglossus nerve). All hemispheric complications recovered completely. During follow-up (median 48 months ranging from 3 to 103 months), 1 patient died of unrelated cause. Another patient developed a contralateral ischemic insult.


CONCLUSIONS
When adjusting treatment to the various etiological conditions and localizations, aneurysms of the extracranial carotid artery can be managed with a low complication rate and satisfying long-term results. However, success mainly depends on the timely diagnosis and availability of a range of surgical and radiological therapeutical options.
Aleksic
M
M
Division of Vascular Surgery, Department of Visceral and Vascular Surgery, University of Cologne, Germany. Marko.Aleksic@medizin.uni-koeln.de
Heckenkamp
J
J
Gawenda
M
M
Brunkwall
J
J
D000783:Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013997:Time Factors