|IMAGES AND TECHNIQUES
|Year : 2019 | Volume
| Issue : 4 | Page : 303-311
VSI CLINICS - Images and Techniques - 1
|Date of Web Publication||20-Dec-2019|
Source of Support: None, Conflict of Interest: None
A new section is being added to IJVES, which essentially depicts the procedures performed by Vascular Surgeons across the country. This would serve as a pictorial library of multitude of vascular pathologies, simple to complex, common to rare and their therapies. We hope this would create awareness among non-vascular specialists about vascular diseases and the treatment modalities offered. This would replace the previous lengthy, text-based CME articles and would be an easier read. It would serve as quick reference to numerous vascular diseases seen by practicing doctors in various specialties across India.
These reports are non-referenced, non-peer reviewed articles. Neither IJVES nor publishers hold the copyright to the contents of this articles
– Editorial Board
|How to cite this article:|
. VSI CLINICS - Images and Techniques - 1. Indian J Vasc Endovasc Surg 2019;6:303-11
| Extra Cranial Carotid Artery Aneurysms (Eccaa)|| |
Extra cranial carotid artery disease usually manifests as occlusive disease of carotid artery bifurcation and is a common cause of hemispheric neurological event – TIAs, amaurosis fugax, evolving stroke and completed stroke. This amenable to preferably surgical or endovascular correction prior to irreversible hemiparesis, to prevent future neurologic events.
Aneurysms in this arterial tree are rare – 0.4 to 4% of all peripheral aneurysms. A 50% increase in diameter compared to the adjacent artery is considered an aneurysm, similar to other areas. They are more common in males and occurs at an earlier age (early 6th decade) than occlusive disease. They can be asymptomatic, presenting as a pulsatile neck mass, or present with neurological symptoms like contralateral TIA or stroke. They can also present with adjacent organ compression (dysphagia) or cranial nerve dysfunction. Hypertension is a common in these patients. About 15 to 20% have contralateral aneurysms, but not associated with aneurysms of other areas.
Peri-tonsillar abscess used to be a common cause for ECCAA, but at present the most common cause is atherosclerosis. It can also be secondary to neck dissection/radiation, trauma, iatrogenic like inadvertent jugular line insertion into the artery, carotid artery dissection and infections. They can be true aneurysms (containing all three layers of arterial wall) or pseudo aneurysms from breach in the arterial wall.
The “gold standard” for diagnostic imaging is DSA (Digital Subtraction Angiography). However, the current preferred imaging modality is CTA (Computed Tomographic Angiogram) or contrast enhanced MRA, with imaging of intra cranial vessels. Initial evaluation should include color duplex ultrasonography.
Since there paucity of data on natural history of ECCAA, it should be repaired when present, though some under 2cms can be observed. In Indian conditions, where some of these patients have little access to specialized care, it might be prudent to repair all ECCAAs.
Plain arterial ligation has high morbidity and mortality. Hence repair with in-line flow to internal carotid artery is strongly recommended. This can be “open” surgical with aneurysm resection/endo-aneurysmorraphy with reconstruction with vein or synthetic graft or minimally invasive endovascular repair with stent-graft or occasionally “hybrid” repair combining the above two. Following are the pictorial illustrations of the procedures performed across India
Editorial Board – IJVES
| ECCAA - Images & Techniques|| |
Dr. P Shivanesan – Trivandrum: Surgical repair
76 year old female presented with two year history of left sided neck swelling, progressively increasing in size. She had left hemispheric TIA a month back. At present no neurologic deficit and she has no other illnesses.
Case 2: A 26/F, 36weeks pregnant, Previous 3 unexplained abortions. Diagnosed as APLA syndrome elsewhere. Presented with acute pain and swelling for 2 weeks duration in Left supraclavicular region. Clinically pulsatile swelling in left supraclavicular fossa. CTA (With lead cover of abdomen), suggestive of aneurysm of Left CCA, Left SCA (with extension of aneurysm to Lt proximal vertebral artery and Left Internal Mammary artery)
Dr. Ajay Savlania – Chandigarh: Surgical repair
Case 1: A ….?? yr old male known CKD (Chronic Kidney Disease) presented with a large, pulsatile right neck mass. Had mild respiratory distress. He had jugular venous cannulation for dialysis
Case 2: A …. Year male with injury???……….. developed a right common carotid pseudo aneurysm
Dr. Narendra Meda – Hyderabad: Surgical Repair
…..?? year old male presented with sudden onset of pulsatile swelling of the right side of the neck with breathlessness. CKD???; jugular cath??; Trauma?? A CT angiogram ???? ruptured pseudo aneurysm proximal to tight common carotid bifurcation. Patient was operated on urgently ???? and underwent resection/evacuation of ruptured pseudo aneurysm and artery was closed primarily. Patients recovery was uneventful???
Prof. Sridharan – Chennai; Surgical Repair
brief details about patient; any imaging?
Dr. Vishnu – Bengaluru: Endovascular repair
45 year old female with two month history progressive, pulsatile swelling right side of the neck, wthout any other symptoms. She has no other illnesses and no history of trauma. Significantly she had right above elbow amputation one month back elsewhere for acute limb ischemia and the stump had healed well.
Minimally invasive Endovascular repair with stent graft was performed through right femoral artery, excluding the flow into the aneurysm. The right subclavian artery was covered with no ill effects since she already had a right above elbow amputation. Recovery was unremarkable
| Suggested Reading|| |
1. Zhou W, Lin PH, et al. Carotid artery aneurysm: Evolution of management over two decades. J Vascular Surgery 2006;43;493-6.
2. Attigha N, et al. Surgical therapy for extra cranial carotid aneurysms; long term results over 24 years. European J Vasc Endov Surg 2009;37;127-33.
3. Li Z, et al. Endovascular stenting of extra cranial carotid artery – A systemic review aneursyms. Eurp J Vasc Endov Surg 2011;42;419-26.