Carotid artery pseudoaneurysm after carotid endarterectomy: case report

Year 2019, Volume: 11 Issue: 2, 207 - 210, 01.06.2019

Hatice Kaplanoğlu , Osman Beton

https://doi.org/10.21601/ortadogutipdergisi.358029

Abstract

Extracranial carotid artery aneurysms
are quite rare. They account for 0.4% to 4% of all peripheral arterial aneurysms.
Precise treatment is essential in order to avoid neurological complications of aneurysms.
A 67-year-old male patient was admitted to the cardiology outpatient clinic of our
hospital three months ago, with complaints of chest pain during exertion. The effort
test of the case revealed a positive result, and coronary angiography revealed stenosis in the coronary arteries.
The carotis doppler ultrasonography revealed plaque in the left internal carotid
artery, causing 80% narrowing in the lumen. Four vessels were determine to be bypassed,
and a left carotid endarterectomy was applied in the same session. Swelling and
cyanosis were present in the patient’s neck two days after the operation. The control
doppler ultrasonography revealed the development of an aneurysm in the left internal
carotid artery. The patient was operated on again one week after the first operation,
and end-to-end anastomosis was applied with a saphenous vein interposition graft.
The decision was made for follow-ups with doppler ultrasonography controls in six-month
intervals.

Keywords

Carotid arteries, carotid aneurysm, surgery, endovascular techniques

Karotid endarterektomi sonrası karotid arter psödoanevrizması: olgu sunumu

Abstract

Ekstrakranial karotid arter anevrizmaları oldukça nadirdir. Tüm periferal arter
anevrizmalarının %0.4-4’ünü oluşturmaktadır. Anevrizmaların nörolojik komplikasyonlarından
kaçınmak için kesin tedavi gerekmektedir. Altmış yedi yaşında erkek hasta, üç ay
önce efor sırasında ortaya çıkan göğüs ağrısı şikayeti ile hastanemiz kardiyoloji
polikliniğine başvuruyor. Olguya yapılan efor testinin pozitif çıktı ve koroner
anjiyografide koroner arterlerde darlık saptandı. Karotis Doppler ultrasonografide,
sol internal karotid arterde %80 darlığa neden olan plak vardı. Dört damar bypass
kararı alındı ve aynı senasta sol karotid endarterektomi yapıldı. Operasyonu takiben
iki gün sonra hastanın boynunda şişlik ve morarma görüldü. Yapılan kontrol Doppler
ultrasonografide sol internal karotid arterde anevrizma geliştiği izlendi. İlk operasyonu
takiben bir hafta sonra tekrar opere edildi ve safen ven greft interpozisyonu ile
uç uca anastamoz yapıldı. Altı aylık Doppler ultrasonografi kontrolleri ile takibi
alındı.

Keywords

Karotid arterler, karotis anevrizması, cerrahi, endovasküler teknikler

References

• Welleweerd JC, den Ruijter HM, Nelissen BG, ve ark. Management of extracranial carotid artery aneurysm. Eur J Vasc Endovasc Surg 2015;50:141-7.
• Radak D, Davidovic L, Vukobratov V, ve ark. Carotid artery aneurysms: Serbian multicentric study. Ann Vasc Surg 2007;21:23-9.
• El-Sabrout R, Cooley DA. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg 2000;31:702-12.
• Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for ArterialAneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North AmericanChapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991;13:452-8.
• Haynes DS , Schwaber MK , Netterville JL. Internal Carotid Artery Anurysm Presenting as Neck Masses. Otolaryngol Head Neck Surg 1992;107:787-91.
• Bower TC, Pairolero PC, Hallett JW Jr, Toomey BJ, Gloviczki P, Cherry KJ Jr. Brachiocephalic aneurysm: The case for early recognation and repair. Ann Vasc Surg 1991;5:125-32.
• Schievink WI, Piepgras DG, McCaffrey TV, Mokri B. Surgical treatment of extracranial internal carotid artery dissecting aneurysms. Neurosurgery 1994;35:809-15.
• Szopinski P, Ciostek P, Kielar M, Myrcha P, Pleban E, Noszczyk W. A series of 15 patients with extracranial carotid artery aneurysms: Surgical and endovascular treatment.Eur J Vasc Endovasc Surg 2005;29:256-61.
• 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.
• Welleweerd JC, Moll FL, de Borst GJ. Technical options for the treatment of extracranial carotid aneurysms. Expert Rev Cardiovasc Ther 2012;10:925-31.
• Choudhary AS, Evans RJ, Naik DK, Tripathi RK, Wickremesekera JK. Surgical management of extracranial carotid artery aneurysms. ANZ J. Surg 2009;79:281-7.
• Malikov S, Thomassin JM, Magnan PE, Keshelava G, Bartoli M, Branchereau A. Open surgical reconstruction of the internal carotid artery aneurysm at the base of the skull. J. Vasc. Surg 2010;51:323-9.
• Bosiers M, Deloose K, Verbist J, Peeters P. Carotid artery stenting: which stent for which lesion? Vascular 2005;13:205-10.
• Taha MM, Nakahara I, Higashi T, Iwamuro Y, Watanabe Y, Taki W. Interventional neuroradiological techniques for the treatment of aneurysms of the supra-aortic extracranial arteries. Neurol Med Chir 2010;50:275-80.
• Loffroy R, Rao P, Ota S, ve ark. Packing technique for endovascular coil embolisation of peripheral arterial pseudo-aneurysms with preservation of the parent artery: safety, efficacy and outcomes. Eur J Vasc Endovasc Surg 2010;40:209-15.