Extracranialis carotis aneurysmák korszerű kezelése

Abstract

Introduction: Aneurysm of the extracranial carotid artery is a rare condition and there is a diversity in the etiology. The proper treatment could be a real challenge for the surgeons. Aim: Analysis of perioperative and long term results of invasive treatment for carotid artery aneurysm. Method: A retrospective review was conducted of patients who had open or endovascular surgery due to carotid artery aneurysm through the last 13 years at the Department of Vascular Surgery of the Semmelweis University and at the Department of Surgery of the University of Szeged. Medical history, characteristics of the aneurysms, therapy and the follow-up results were reviewed. Results: Over the study period, 25 interventions were performed due to carotid artery aneurysm. There were 10 men and 15 women with a mean age of 57.8 ± 15.15 years. Seventeen patients (68%) were symptomatic. The mean aneurysm diameter was 26.8 ± 11.25 mm. The underlying etiology was atherosclerosis in eleven (44%), prior carotid endarterectomy in four (16%), infection in four (16%) and other cause (connective tissue disease, dissection, trauma) in six (24%) cases. Nineteen patients underwent open surgery, six underwent endovascular treatment. Death within 30 days was documented in one (4%) case. The mean postoperative hospital stay was 4.52 ± 2.38 days. Three (12%) patients required reintervention postoperatively. Peripheral nerve injuries were detected in four (16%) patients, all after open surgery. No stroke was documented within 30 days. The mean follow-up was 41.2 ± 38.54 months. Five (24%) deaths were not related to the carotid artery disease. One patient had stroke, one had transient ischaemic attack (TIA), and in two cases asymptomatic internal carotid artery occlusion was described. Conclusion: Both open surgery and endovascular intervention can be safely applied in the treatment of carotid artery aneurysm. Considering the variable etiology and rarity, we recommend to perform the interventions in vascular surgery centres. Orv Hetil. 2019; 160(21): 815–821.

Surgical Repair of Internal Carotid Artery Aneurysm: Case Report

“…The most important problem in endovascular procedures is that the rate of reprocessing such as re-stenosis is higher than surgical operations. 12,13 Endovascular therapies should be recommended to patients when there is no healthy ICA other than the extracranial aneurysm or there is not enough ICA length to be taken under control. Treatment modality of carotid artery aneurysm has largely evolved from operative to endovascular intervention at many institutions.…”

“…Regarding both forms of treatment, the decisive factors are risk of cranial nerve damage, re-intervention necessity, mortality, length of hospital stay, and frequency of cerebrovascular events. 3,12,13 Various studies have shown that surgical treatment is one of the effective treatment methods in carotid aneurysms. 1,8,13 The localization, etiology, clinical development and operative approaches of the lesions were investigated.…”

“…3,12,13 Various studies have shown that surgical treatment is one of the effective treatment methods in carotid aneurysms. 1,8,13 The localization, etiology, clinical development and operative approaches of the lesions were investigated. The indication for surgical treatment was defined as the increase in the internal carotid artery (ICA) diameter and an increase of more than 50% of the common carotid artery.…”

A szegedi Sebészeti Klinika története a tudományos eredmények tükrében

“…A carotis sebészetébenamely szakmánk folyamatosan reflektorfényben lévő területe -1996- tól a legjobb hosszú távú eredményeket biztosító technikát az eversios endarterectomiát alkalmazzuk. 2018-tól a perioperatív morbiditás csökkentése és a betegbiztonság fokozása céljából meghonosítottuk a direkt neuromonitoringot lehetővé tevő lokoregionalis anaesthesiát [72][73][74].…”

Clinical Analysis of Interventional Therapy for Eight Cases of Extracranial ICA Aneurysm

“… 1 The most common underlying causes related to these true aneurysms include atherosclerosis, trauma, fibromuscular dysplasia, infection, connective tissue disorders, and large vessel vasculitis. 2 EICA generally has no obvious clinical symptoms. Some patients usually show pain, throbbing masses or cranial nerve palsy.…”