Extracranial Carotid Artery Aneurysms: Long-term Results of Open Repair

Abstract

Extracranial carotid artery (ECA) aneurysms are rare, but the potential risk of rupture or thromboembolism argues for early treatment. Our goal was to determine complications and long-term outcome of open surgical repair. Clinical data of 27 patients (13 women, 14 men; mean age, 65 years) treated for ECA aneurysm at our institution between 1990 and 2009 were retrospectively reviewed. The mean ECA aneurysm size was 3.9 cm (range, 1.2-6.5 cm). Etiology in the 27 patients was pseudoaneurysm after prior carotid surgery (37%), fibromuscular dysplasia (14%), trauma (19%), atherosclerosis (19%), infection (7%), and Marfan syndrome (4%). The 22 nontraumatic aneurysms involved the internal carotid artery (ICA), and the 5 traumatic aneurysms involved the common carotid artery. Pulsatile neck mass was present in 16 patients (59%), an audible bruit was identified in 12 (44%), and 14 (56%) had a documented preoperative transient ischemic attack or stroke. Nine patients (33%) presented with concomitant aneurysms, most commonly involving the abdominal aorta. All patients underwent elective open surgical repair, including resection in 22, with interposition bypass grafting (50%), end-to-end primary repair (23%), or patch angioplasty (27%); carotid ligation in 3; and aneurysmorrhaphy in 2. There were no perioperative deaths. One patient (3.7%) sustained a neurologic embolic event with permanent visual field deficits. Transient cranial nerve injury occurred in three patients (14%), all associated with repeat surgery or high cervical lesions. During a mean follow-up of 7 years, no strokes, neurologic events, or recurrent aneurysms occurred, and five patients died of cardiac causes. Open surgical repair of ECA aneurysms can be accomplished with minimal morbidity and excellent long-term results. For most patients, open repair remains the gold standard of treatment. Patients requiring redo surgery or with distal cervical lesions have increased risk of temporary nerve injury and, therefore, may be a subgroup that would benefit from percutaneous treatment.