Jiehua Qiu1, Weimin Zhou2, Xianhua Zhu3, Wei Zhou3, Qinfu Zeng3, Li Huang3, Xinhua Tang3, Qingwen Yuan3. 1. Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China. Electronic address: qiujiehua2010@163.com. 2. Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China. Electronic address: drzwm2010@163.com. 3. Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China.
Abstract
OBJECTIVE: The purpose of this study is to record our institution's experience in the management of extracranial carotid artery aneurysms (ECCAs) over the past 15 years. METHODS: A retrospective chart review was performed on consecutive ECCA patients from April 2003 to December 2017. Outpatient and inpatient clinic charts were reviewed. All the patients were treated by open surgery between 2003 and 2008. For other patients, the treatment methods included open surgery, endovascular surgery, and hybrid operations which were dependent on the aneurysm anatomy, as well as conservative management. In open series, carotid shunt was applied and Transcranial Color Doppler (TCD) was selectively used for intraoperative monitoring of cerebral blood flow. The resected aneurysm sacs were tested with hematoxylin and eosin (HE) stains. Each case was reexamined one month after the patients were discharged from the hospital. A questionnaire survey, a clinical examination, and duplex ultrasonography or computed tomography angiography imaging were carried out. The patients were then reexamined three and six months after surgery, then annually. RESULTS: Thirty ECCAs were treated in 30 patients - 14 males and 16 females, with a mean age of 54 ± 13 years. Four types of carotid aneurysms were identified: Type I, II, III and V, with 17, 3, 1 and 9 patients, respectively. From 2003 to 2008, there were eight patients (Type I: seven; Type II: one), and all of them were treated by open surgery, and one suffered transient cranial nerve palsy. From 2009-2017, two patients were treated with conservative management; ten were treated with open surgery; nine were treated with endovascular surgery; and one was treated with hybrid operation. Among the open surgery patients, two suffered neck hematoma. All patients recovered well without complications in the endovascular surgery group. Twenty-seven patients presented for follow-up and without contralateral aneurysms or other complications. CONCLUSIONS: The optimal treatment of ECCA is dependent on the morphology of the carotid artery and properties of aneurysms. Open surgical repair is a suitable and safe procedure for Type I ECCAs when they concomitant with kinking in the internal carotid artery. Endovascular treatment is an effective alternative to open surgery for false ECCA repair.
OBJECTIVE: The purpose of this study is to record our institution's experience in the management of extracranial carotid artery aneurysms (ECCAs) over the past 15 years. METHODS: A retrospective chart review was performed on consecutive ECCA patients from April 2003 to December 2017. Outpatient and inpatient clinic charts were reviewed. All the patients were treated by open surgery between 2003 and 2008. For other patients, the treatment methods included open surgery, endovascular surgery, and hybrid operations which were dependent on the aneurysm anatomy, as well as conservative management. In open series, carotid shunt was applied and Transcranial Color Doppler (TCD) was selectively used for intraoperative monitoring of cerebral blood flow. The resected aneurysm sacs were tested with hematoxylin and eosin (HE) stains. Each case was reexamined one month after the patients were discharged from the hospital. A questionnaire survey, a clinical examination, and duplex ultrasonography or computed tomography angiography imaging were carried out. The patients were then reexamined three and six months after surgery, then annually. RESULTS: Thirty ECCAs were treated in 30 patients - 14 males and 16 females, with a mean age of 54 ± 13 years. Four types of carotid aneurysms were identified: Type I, II, III and V, with 17, 3, 1 and 9 patients, respectively. From 2003 to 2008, there were eight patients (Type I: seven; Type II: one), and all of them were treated by open surgery, and one suffered transient cranial nerve palsy. From 2009-2017, two patients were treated with conservative management; ten were treated with open surgery; nine were treated with endovascular surgery; and one was treated with hybrid operation. Among the open surgery patients, two suffered neck hematoma. All patients recovered well without complications in the endovascular surgery group. Twenty-seven patients presented for follow-up and without contralateral aneurysms or other complications. CONCLUSIONS: The optimal treatment of ECCA is dependent on the morphology of the carotid artery and properties of aneurysms. Open surgical repair is a suitable and safe procedure for Type I ECCAs when they concomitant with kinking in the internal carotid artery. Endovascular treatment is an effective alternative to open surgery for false ECCA repair.