Valeria Silvestri1, Cristian Borrazzo2, Rita Mele3, Gabriella d'Ettorre2. 1. Surgical Science Department, La Sapienza University, Roma, Italy. Electronic address: valeria.silvestri@uniroma1.it. 2. Department of Public Health and Infectious Disease, Sapienza University of Rome, Roma, Italy. 3. Surgical Science Department, La Sapienza University, Roma, Italy.
Abstract
BACKGROUND: HIV infection may affect the cardiovascular system through different physiopathological patterns. Rarely reported in HIV negative patients, aneurysms involving the carotid artery have been described for the first time in seropositive patients in 1989. AIMS: In our study, we have focused on aneurysm pathology affecting carotid arteries in HIV patients, analyzing clinical and surgical presentation, management, and outcome, through a review of cases published in the literature. METHODS: The MEDLINE (www.ncbi.nlm.nih.gov/pubmed) database was reviewed for "carotid artery aneurysm AND HIV OR AIDS OR immunodeficiency." RESULTS: Nineteen articles including a total of 46 cases were included in our report. The mean age of patients was 30.6 ± 14.2 years; 30 patients (65.2%) were male. Aneurysms were localized in the intracranial carotid (41.3%) or extracranial artery (58%). Presenting features included symptoms due to compression of neck structures; positivity for neurological symptoms occurred in 36.9%. Patients were managed surgically in 58.7% of cases; surgical morbidity and mortality were of 22.2% and 7.4% respectively, higher for endovascular procedures. The overall mortality in treated and untreated cases was 26.1%. CONCLUSIONS: Aneurysms may occur in both the extracranial and intracranial carotid artery in patients with HIV at younger age than in non-HIV patients and are linked to a high morbidity and mortality. Seropositivity must be ruled out whenever this rare vascular condition may occur in the absence of a more likely aetiology and must also be suspected in HIV patients presenting with compressive symptoms of the neck, neurological impairment or stroke.
BACKGROUND:HIV infection may affect the cardiovascular system through different physiopathological patterns. Rarely reported in HIV negative patients, aneurysms involving the carotid artery have been described for the first time in seropositive patients in 1989. AIMS: In our study, we have focused on aneurysm pathology affecting carotid arteries in HIVpatients, analyzing clinical and surgical presentation, management, and outcome, through a review of cases published in the literature. METHODS: The MEDLINE (www.ncbi.nlm.nih.gov/pubmed) database was reviewed for "carotid artery aneurysm AND HIV OR AIDS OR immunodeficiency." RESULTS: Nineteen articles including a total of 46 cases were included in our report. The mean age of patients was 30.6 ± 14.2 years; 30 patients (65.2%) were male. Aneurysms were localized in the intracranial carotid (41.3%) or extracranial artery (58%). Presenting features included symptoms due to compression of neck structures; positivity for neurological symptoms occurred in 36.9%. Patients were managed surgically in 58.7% of cases; surgical morbidity and mortality were of 22.2% and 7.4% respectively, higher for endovascular procedures. The overall mortality in treated and untreated cases was 26.1%. CONCLUSIONS:Aneurysms may occur in both the extracranial and intracranial carotid artery in patients with HIV at younger age than in non-HIVpatients and are linked to a high morbidity and mortality. Seropositivity must be ruled out whenever this rare vascular condition may occur in the absence of a more likely aetiology and must also be suspected in HIVpatients presenting with compressive symptoms of the neck, neurological impairment or stroke.