Supra-aortic vessels aneurysms: diagnosis and prompt intervention.
OBJECTIVE
Aneurysms involving the supra-aortic vessels are rare but carry serious risk of embolization, thrombosis, and rupture. We describe our experience with the diagnosis, treatment strategies, and outcomes in patients with extended follow-up.


METHODS
Data during a 17-year period (January 1990 to December 2007) was analyzed. We assessed age, gender, presenting symptoms, localization, pathologic diagnosis, type of procedures, complications, and survival.


RESULTS
A total of 74 patients were treated for supra-aortic aneurysms. Of all aneurysms treated, 63% were degenerative, 24% iatrogenic, 8% traumatic, 3% genetic, and 1% mycotic. The subclavian artery was most commonly affected (50%, 2/3 in the right side), followed by the common carotid (36%), internal carotid (10%), innominate (3%), and vertebral (1%). At the time of diagnosis, 52 patients (70%) were asymptomatic, but of those symptomatic 68% had an embolic event as a presenting symptom. Embolic episodes were more common in patients with smaller aneurysms (P < .006). Open surgery was performed in 77% of all cases, and the use of endovascular techniques became the predominant treatment modality over the last 4 years. Survival at 30 days was 100%. Five- and 10-year survival rates were 87% and 43%, respectively.


CONCLUSIONS
Most cases of supra-aortic aneurysm are asymptomatic and embolization as opposed to rupture represents the greatest risk to the patient. Most cases can be detected prior to symptoms. Endovascular repair is an emerging alternative of treatment and, with the current development of appropriate devices, will likely form the mainstay of therapy in the near future.
Cury
Marcelo
M
Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Greenberg
Roy K
RK
Morales
Jose P
JP
Mohabbat
Walid
W
Hernandez
Adrian V
AV
D000368:Aged; D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001158:Arteries / Q000473:pathology* / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000601:surgery; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery