Surgical and medical management of extracranial carotid artery aneurysms

Grant Fankhauser, William M. Stone, Richard J. Fowl, Mark E. O'Donnell, Thomas C. Bower, Fredric B. Meyer, Samuel R. Money

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective Extracranial carotid artery aneurysms (ECCAs) are extremely rare with limited information about management options. Our purpose was to review our institution's experience with ECCAs during 15 years and to discuss the presentation and treatment of these aneurysms. Methods A retrospective review of patients diagnosed with ECCAs from 1998 to 2012 was performed. Symptoms, risk factors, etiology, diagnostic methods, treatments, and outcomes were reviewed. Results During the study period, 141 aneurysms were diagnosed in 132 patients (mean age, 61 years; 69 men). There were 116 (82%) pseudoaneurysms and 25 (18%) true aneurysms; 69 (49%) aneurysms were asymptomatic, whereas 72 (52%) had symptoms (28 painless masses; 10 transient ischemic attacks; 10 vision symptoms; 9 ruptures; 8 strokes; 4 painful mass; 1 dysphagia; 1 tongue weakness; 1 bruit). Causes of true aneurysms included fibromuscular dysplasia in 15 patients, Ehlers-Danlos syndrome in three, Marfan syndrome in one, and uncharacterized connective tissue diseases in two. Of 25 true aneurysms, 11 (44%) were symptomatic; 15 (60%) true aneurysms underwent open surgical treatment, whereas 10 (40%) were managed nonoperatively. Postoperative complications included one stroke during a mean follow-up of 31 months (range, 0-166 months). No aneurysms managed nonoperatively required intervention during a mean follow-up of 77 months (range, 1-115 months). Of 116 pseudoaneurysms, 60 (52%) were symptomatic; 33 (29%) pseudoaneurysms underwent open surgery, 18 (15%) underwent endovascular intervention, and 65 (56%) were managed medically. Pseudoaneurysm after endarterectomy (28 patients; 24%) presented at a mean of 82 months from the surgical procedure. Mean follow-up for all aneurysms was 33.9 months. One (0.7%) aneurysm-related death occurred (rupture treated palliatively). No patient undergoing nonoperative management suffered death or major morbidity related to the aneurysm. Nonoperative management was more common in asymptomatic patients (71%) than in symptomatic patients (31%). Conclusions ECCAs are uncommon and may be manifested with varying symptoms. All segments of the carotid artery are susceptible, although the internal is most commonly affected. Open surgical intervention was more common in patients with symptoms and with true aneurysms. Patients with pseudoaneurysms were more likely to undergo endovascular intervention. Nonoperative treatment is safe in selected patients.

Original languageEnglish (US)
Pages (from-to)389-393
Number of pages5
JournalJournal of Vascular Surgery
Volume61
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

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Carotid Arteries
Aneurysm
False Aneurysm
Rupture
Stroke
Fibromuscular Dysplasia
Ehlers-Danlos Syndrome
Information Management
Marfan Syndrome
Endarterectomy
Connective Tissue Diseases
Transient Ischemic Attack
Deglutition Disorders
Tongue
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Medicine(all)

Cite this

Fankhauser, G., Stone, W. M., Fowl, R. J., O'Donnell, M. E., Bower, T. C., Meyer, F. B., & Money, S. R. (2015). Surgical and medical management of extracranial carotid artery aneurysms. Journal of Vascular Surgery, 61(2), 389-393. https://doi.org/10.1016/j.jvs.2014.07.092

Surgical and medical management of extracranial carotid artery aneurysms. / Fankhauser, Grant; Stone, William M.; Fowl, Richard J.; O'Donnell, Mark E.; Bower, Thomas C.; Meyer, Fredric B.; Money, Samuel R.

In: Journal of Vascular Surgery, Vol. 61, No. 2, 01.02.2015, p. 389-393.

Research output: Contribution to journalArticle

Fankhauser, G, Stone, WM, Fowl, RJ, O'Donnell, ME, Bower, TC, Meyer, FB & Money, SR 2015, 'Surgical and medical management of extracranial carotid artery aneurysms', Journal of Vascular Surgery, vol. 61, no. 2, pp. 389-393. https://doi.org/10.1016/j.jvs.2014.07.092
Fankhauser, Grant ; Stone, William M. ; Fowl, Richard J. ; O'Donnell, Mark E. ; Bower, Thomas C. ; Meyer, Fredric B. ; Money, Samuel R. / Surgical and medical management of extracranial carotid artery aneurysms. In: Journal of Vascular Surgery. 2015 ; Vol. 61, No. 2. pp. 389-393.
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abstract = "Objective Extracranial carotid artery aneurysms (ECCAs) are extremely rare with limited information about management options. Our purpose was to review our institution's experience with ECCAs during 15 years and to discuss the presentation and treatment of these aneurysms. Methods A retrospective review of patients diagnosed with ECCAs from 1998 to 2012 was performed. Symptoms, risk factors, etiology, diagnostic methods, treatments, and outcomes were reviewed. Results During the study period, 141 aneurysms were diagnosed in 132 patients (mean age, 61 years; 69 men). There were 116 (82{\%}) pseudoaneurysms and 25 (18{\%}) true aneurysms; 69 (49{\%}) aneurysms were asymptomatic, whereas 72 (52{\%}) had symptoms (28 painless masses; 10 transient ischemic attacks; 10 vision symptoms; 9 ruptures; 8 strokes; 4 painful mass; 1 dysphagia; 1 tongue weakness; 1 bruit). Causes of true aneurysms included fibromuscular dysplasia in 15 patients, Ehlers-Danlos syndrome in three, Marfan syndrome in one, and uncharacterized connective tissue diseases in two. Of 25 true aneurysms, 11 (44{\%}) were symptomatic; 15 (60{\%}) true aneurysms underwent open surgical treatment, whereas 10 (40{\%}) were managed nonoperatively. Postoperative complications included one stroke during a mean follow-up of 31 months (range, 0-166 months). No aneurysms managed nonoperatively required intervention during a mean follow-up of 77 months (range, 1-115 months). Of 116 pseudoaneurysms, 60 (52{\%}) were symptomatic; 33 (29{\%}) pseudoaneurysms underwent open surgery, 18 (15{\%}) underwent endovascular intervention, and 65 (56{\%}) were managed medically. Pseudoaneurysm after endarterectomy (28 patients; 24{\%}) presented at a mean of 82 months from the surgical procedure. Mean follow-up for all aneurysms was 33.9 months. One (0.7{\%}) aneurysm-related death occurred (rupture treated palliatively). No patient undergoing nonoperative management suffered death or major morbidity related to the aneurysm. Nonoperative management was more common in asymptomatic patients (71{\%}) than in symptomatic patients (31{\%}). Conclusions ECCAs are uncommon and may be manifested with varying symptoms. All segments of the carotid artery are susceptible, although the internal is most commonly affected. Open surgical intervention was more common in patients with symptoms and with true aneurysms. Patients with pseudoaneurysms were more likely to undergo endovascular intervention. Nonoperative treatment is safe in selected patients.",
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N2 - Objective Extracranial carotid artery aneurysms (ECCAs) are extremely rare with limited information about management options. Our purpose was to review our institution's experience with ECCAs during 15 years and to discuss the presentation and treatment of these aneurysms. Methods A retrospective review of patients diagnosed with ECCAs from 1998 to 2012 was performed. Symptoms, risk factors, etiology, diagnostic methods, treatments, and outcomes were reviewed. Results During the study period, 141 aneurysms were diagnosed in 132 patients (mean age, 61 years; 69 men). There were 116 (82%) pseudoaneurysms and 25 (18%) true aneurysms; 69 (49%) aneurysms were asymptomatic, whereas 72 (52%) had symptoms (28 painless masses; 10 transient ischemic attacks; 10 vision symptoms; 9 ruptures; 8 strokes; 4 painful mass; 1 dysphagia; 1 tongue weakness; 1 bruit). Causes of true aneurysms included fibromuscular dysplasia in 15 patients, Ehlers-Danlos syndrome in three, Marfan syndrome in one, and uncharacterized connective tissue diseases in two. Of 25 true aneurysms, 11 (44%) were symptomatic; 15 (60%) true aneurysms underwent open surgical treatment, whereas 10 (40%) were managed nonoperatively. Postoperative complications included one stroke during a mean follow-up of 31 months (range, 0-166 months). No aneurysms managed nonoperatively required intervention during a mean follow-up of 77 months (range, 1-115 months). Of 116 pseudoaneurysms, 60 (52%) were symptomatic; 33 (29%) pseudoaneurysms underwent open surgery, 18 (15%) underwent endovascular intervention, and 65 (56%) were managed medically. Pseudoaneurysm after endarterectomy (28 patients; 24%) presented at a mean of 82 months from the surgical procedure. Mean follow-up for all aneurysms was 33.9 months. One (0.7%) aneurysm-related death occurred (rupture treated palliatively). No patient undergoing nonoperative management suffered death or major morbidity related to the aneurysm. Nonoperative management was more common in asymptomatic patients (71%) than in symptomatic patients (31%). Conclusions ECCAs are uncommon and may be manifested with varying symptoms. All segments of the carotid artery are susceptible, although the internal is most commonly affected. Open surgical intervention was more common in patients with symptoms and with true aneurysms. Patients with pseudoaneurysms were more likely to undergo endovascular intervention. Nonoperative treatment is safe in selected patients.

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