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Extracranial internal carotid artery aneurysm
VASCULAR IMAGES
Extracranial internal carotid artery aneurysm John D. Kakisis, MD, Triantafillos G. Giannakopoulos, MD, Konstantinos Moulakakis, MD, and Christos D. Liapis, MD, Athens, Greece
Extracranial internal carotid artery aneurysms are rare but dangerous, associated with a high risk of neurological thromboembolic events, cranial nerve compression, and, more rarely, rupture.1-3 A 74-year-old male was admitted to our hospital because of a pulsatile mass at the left side of the neck, below the angle of the mandible. The patient reported that he had noticed the mass for the first time 5 years before. The mass had been considered to derive from the left submandibular gland, and a fine needle aspiration was performed, which was negative for malignancy. Over the past few months, the size of the mass increased rapidly, and its pulsatile nature became more evident. The patient was submitted to a color Duplex scan, which revealed the presence of an aneurysm of a kinked left internal carotid artery (ICA). A computed tomography angiography followed, verifying the presence of a giant aneurysm of the left ICA, measuring 7 cm in diameter (A/Cover). The ICA was kinked 2 cm distally to the carotid bifurcation, and after 3 more cm, a saccular aneurysm arose with no intraluminal thrombus. The huge aneurysm was displacing the distal ICA laterally, so that the proximal and the distal part of the ICA were almost in contact. The anatomy of the aneurysm made endovascular treatment impossible, due to the kinking of the ICA, but it facilitated open surgical repair, due to the elongation of the ICA and the fact that both the proximal and the distal part of the ICA were displaced laterally and in close proximity with each other. The patient was taken to the operating room and, under general anesthesia, a standard anterior sternocleidomastoid incision was made. The carotid bifurcation, the proximal and the distal part of the ICA were exposed (B), and the aneurysm was ligated proximally and distally. The continuity of the ICA was restored with a beveled end-to-end anastomosis compensating for the significant diameter mismatch between the two parts of the ICA (C). The aneurysm was not resected, but its 40-mL content was evacuated by needle puncture and aspiration with a syringe. The postoperative course was uneventful. Informed consent to the publication of his anonymous data was obtained from the patient. REFERENCES 1. Zwolak RM, Whitehouse WM Jr, Knake JE, Bernfeld BD, Zelenock GB, Cronenwett JL, et al. Atherosclerotic extracranial carotid artery aneurysms. J Vasc Surg 1984;1:415-22. 2. El-Sabrout R, Cooley DA. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg 2000;31:702-12. 3. Rosset E, Albertini JN, Magnan PE, Ede B, Thomassin JM, Branchereau A. Surgical treatment of extracranial internal carotid artery aneurysms. J Vasc Surg 2000;31:713-23. Submitted Nov 6, 2012; accepted Sep 10, 2013. From the Department of Vascular Surgery, Athens University Medical School, “Attikon” Hospital. Author conflict of interest: none. E-mail: [email protected]. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. J Vasc Surg 2014;60:1358 0741-5214/$36.00 Copyright Ó 2014 by the Society for Vascular Surgery. http://dx.doi.org/10.1016/j.jvs.2013.09.014
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Extracranial internal carotid artery aneurysm John D. Kakisis, MD, Triantafillos G. Giannakopoulos, MD, Konstantinos Moulakakis, MD, and Christos D. Liapis, MD, Athens, Greece
Extracranial internal carotid artery aneurysms are rare but dangerous, associated with a high risk of neurological thromboembolic events, cranial nerve compression, and, more rarely, rupture.1-3 A 74-year-old male was admitted to our hospital because of a pulsatile mass at the left side of the neck, below the angle of the mandible. The patient reported that he had noticed the mass for the first time 5 years before. The mass had been considered to derive from the left submandibular gland, and a fine needle aspiration was performed, which was negative for malignancy. Over the past few months, the size of the mass increased rapidly, and its pulsatile nature became more evident. The patient was submitted to a color Duplex scan, which revealed the presence of an aneurysm of a kinked left internal carotid artery (ICA). A computed tomography angiography followed, verifying the presence of a giant aneurysm of the left ICA, measuring 7 cm in diameter (A/Cover). The ICA was kinked 2 cm distally to the carotid bifurcation, and after 3 more cm, a saccular aneurysm arose with no intraluminal thrombus. The huge aneurysm was displacing the distal ICA laterally, so that the proximal and the distal part of the ICA were almost in contact. The anatomy of the aneurysm made endovascular treatment impossible, due to the kinking of the ICA, but it facilitated open surgical repair, due to the elongation of the ICA and the fact that both the proximal and the distal part of the ICA were displaced laterally and in close proximity with each other. The patient was taken to the operating room and, under general anesthesia, a standard anterior sternocleidomastoid incision was made. The carotid bifurcation, the proximal and the distal part of the ICA were exposed (B), and the aneurysm was ligated proximally and distally. The continuity of the ICA was restored with a beveled end-to-end anastomosis compensating for the significant diameter mismatch between the two parts of the ICA (C). The aneurysm was not resected, but its 40-mL content was evacuated by needle puncture and aspiration with a syringe. The postoperative course was uneventful. Informed consent to the publication of his anonymous data was obtained from the patient. REFERENCES 1. Zwolak RM, Whitehouse WM Jr, Knake JE, Bernfeld BD, Zelenock GB, Cronenwett JL, et al. Atherosclerotic extracranial carotid artery aneurysms. J Vasc Surg 1984;1:415-22. 2. El-Sabrout R, Cooley DA. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg 2000;31:702-12. 3. Rosset E, Albertini JN, Magnan PE, Ede B, Thomassin JM, Branchereau A. Surgical treatment of extracranial internal carotid artery aneurysms. J Vasc Surg 2000;31:713-23. Submitted Nov 6, 2012; accepted Sep 10, 2013. From the Department of Vascular Surgery, Athens University Medical School, “Attikon” Hospital. Author conflict of interest: none. E-mail: [email protected]. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. J Vasc Surg 2014;60:1358 0741-5214/$36.00 Copyright Ó 2014 by the Society for Vascular Surgery. http://dx.doi.org/10.1016/j.jvs.2013.09.014
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