Extra-cranial internal carotid aneurysm repair – the importance of technical details
BACKGROUND: Extracranial internal carotid aneurysms are extremely rare and usually diagnosed as incidental findings although thromboembolic events or rupture can occur. Historically treated by open surgery, endovascular repair is emerging as an alternative. We present our center’s experience with b...
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| Format: | Article |
| Language: | Portuguese |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2024-03-01
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| Series: | Angiologia e Cirurgia Vascular |
| Subjects: | |
| Online Access: | https://acvjournal.com/index.php/acv/article/view/555 |
| _version_ | 1797279342865154048 |
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| author | Andreia Pinelo Daniel Mendes Duarte Rego Luís Loureiro Rui Machado |
| author_facet | Andreia Pinelo Daniel Mendes Duarte Rego Luís Loureiro Rui Machado |
| author_sort | Andreia Pinelo |
| collection | DOAJ |
| description |
BACKGROUND: Extracranial internal carotid aneurysms are extremely rare and usually diagnosed as incidental findings although thromboembolic events or rupture can occur. Historically treated by open surgery, endovascular repair is emerging as an alternative. We present our center’s experience with both approaches.
CASE REPORTS: Four internal carotid aneurysm cases are presented:
Case 1 – 60-year-old male presented with an asymptomatic 20mm saccular aneurysm of the carotid bifurcation. He underwent arterial reconstruction with a bypass using a 6mm ePTFE graft and reimplantation of the external carotid artery.
Case 2 – 61-year-old female presents with an asymptomatic 17mm saccular aneurysm of the internal carotid artery. Aneurismectomy and direct reconstruction through an end-to-end anastomosis was possible due to artery redundancy.
Case 3 – 36-year-old patient with a history of Cushing's syndrome due to a secretory adenoma of the pituitary gland presented with an 19mm fusiform aneurysm of the internal carotid artery. After pituitary gland tumor recession, he underwent arterial reconstruction with an inlay saphenous vein bypass.
Case 4 – 77-year-old female presents with a 27mm saccular aneurysm of the internal carotid artery. Endovascular aneurysm exclusion using a self-expandable covered stent was performed through a cervical carotid surgical approach. Stent occlusion was observed in the postoperative period but without neurological symptoms.
CONCLUSION: Existing data on endovascular treatment’s short- and medium-term outcomes are comparable to surgery, but long-term results are unknown and high rates of technical failure have been associated to artery tortuosity. There are no specific guidelines to guide decision-making and treatment decisions must be individualized according to the morphology and location of the aneurysm and patient's comorbidities.
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| first_indexed | 2024-03-07T16:23:56Z |
| format | Article |
| id | doaj.art-b7fb6155fea54038855f2e8844599b1a |
| institution | Directory Open Access Journal |
| issn | 1646-706X 2183-0096 |
| language | Portuguese |
| last_indexed | 2024-03-07T16:23:56Z |
| publishDate | 2024-03-01 |
| publisher | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| record_format | Article |
| series | Angiologia e Cirurgia Vascular |
| spelling | doaj.art-b7fb6155fea54038855f2e8844599b1a2024-03-03T23:40:54ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962024-03-0119410.48750/acv.555Extra-cranial internal carotid aneurysm repair – the importance of technical detailsAndreia Pinelo0Daniel Mendes1Duarte Rego2Luís Loureiro3Rui Machado4Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, PortugalDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, PortugalDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, PortugalDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, PortugalDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, Portugal BACKGROUND: Extracranial internal carotid aneurysms are extremely rare and usually diagnosed as incidental findings although thromboembolic events or rupture can occur. Historically treated by open surgery, endovascular repair is emerging as an alternative. We present our center’s experience with both approaches. CASE REPORTS: Four internal carotid aneurysm cases are presented: Case 1 – 60-year-old male presented with an asymptomatic 20mm saccular aneurysm of the carotid bifurcation. He underwent arterial reconstruction with a bypass using a 6mm ePTFE graft and reimplantation of the external carotid artery. Case 2 – 61-year-old female presents with an asymptomatic 17mm saccular aneurysm of the internal carotid artery. Aneurismectomy and direct reconstruction through an end-to-end anastomosis was possible due to artery redundancy. Case 3 – 36-year-old patient with a history of Cushing's syndrome due to a secretory adenoma of the pituitary gland presented with an 19mm fusiform aneurysm of the internal carotid artery. After pituitary gland tumor recession, he underwent arterial reconstruction with an inlay saphenous vein bypass. Case 4 – 77-year-old female presents with a 27mm saccular aneurysm of the internal carotid artery. Endovascular aneurysm exclusion using a self-expandable covered stent was performed through a cervical carotid surgical approach. Stent occlusion was observed in the postoperative period but without neurological symptoms. CONCLUSION: Existing data on endovascular treatment’s short- and medium-term outcomes are comparable to surgery, but long-term results are unknown and high rates of technical failure have been associated to artery tortuosity. There are no specific guidelines to guide decision-making and treatment decisions must be individualized according to the morphology and location of the aneurysm and patient's comorbidities. https://acvjournal.com/index.php/acv/article/view/555Aneurysmextracranial carotid arteryendovascularsurgical repair |
| spellingShingle | Andreia Pinelo Daniel Mendes Duarte Rego Luís Loureiro Rui Machado Extra-cranial internal carotid aneurysm repair – the importance of technical details Angiologia e Cirurgia Vascular Aneurysm extracranial carotid artery endovascular surgical repair |
| title | Extra-cranial internal carotid aneurysm repair – the importance of technical details |
| title_full | Extra-cranial internal carotid aneurysm repair – the importance of technical details |
| title_fullStr | Extra-cranial internal carotid aneurysm repair – the importance of technical details |
| title_full_unstemmed | Extra-cranial internal carotid aneurysm repair – the importance of technical details |
| title_short | Extra-cranial internal carotid aneurysm repair – the importance of technical details |
| title_sort | extra cranial internal carotid aneurysm repair the importance of technical details |
| topic | Aneurysm extracranial carotid artery endovascular surgical repair |
| url | https://acvjournal.com/index.php/acv/article/view/555 |
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