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Ann Thorac Surg 2006;81:1943
© 2006 The Society of Thoracic Surgeons

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Correspondence

Extracranial Carotid Aneurysms in Young Patients

Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695 011 India

(Email: unni{at}sctimst.ac.in).

To the Editor:

We read with interest the report by Botí and colleagues [1] regarding the use of deep hypothermic circulatory arrest for repair of an extracranial carotid aneurysm. The authors have not arrived at a conclusion regarding the diagnosis, and they have used a complex technique of hypothermic circulatory arrest for repair [1].

We come across a relatively high incidence of extracranial carotid aneurysms in young patients in our part of the world. The diagnosis most often is Takayasu's arteritis (TA) and less commonly the aneurysm is mycotic. Classical features of TA are found in many patients, but some present with localized arterial abnormalities. A histopathologic examination of the aneurysm wall would have clinched the diagnosis. Over a 15-year period we have operated on 9 cases of extracranial carotid aneurysm in young patients (mean age, 28 years). Four cases had an aneurysm of the internal carotid arteries, four had an aneurysm of the common carotid, and two had localized external carotid aneurysms.

Repair was undertaken in all patients through a similar approach as Botí and colleagues [1] used. We have not used circulatory arrest in any patient. Dissection proceeds on a perianeurymal plane taking care to protect the cranial nerves; sometimes the nerves are enclosed in the aneurysm wall and may need to be sacrificed. Distal and proximal control is achieved and repair can be performed with a variety of techniques, including interposition graft with saphenous vein or prosthetic graft, exclusion graft and excision with reimplantation, depending on the size and extent of the aneurysm and tissue quality. We have not used any shunts for cerebral protection. Controversy surrounds the best repair with proponents for both saphenous vein and prosthetic material [2, 3].

There was no mortality or stroke. We have a follow-up on all these patients ranging from 4 months to 13 years. There was one early and one late pseudoaneurysm formation and both patients underwent successful percutaneous stenting. Three of the prosthetic grafts had significant stenosis at last follow-up.

Inflammatory disease such as Takayasu's is prone to reactivation of latent inflammation with periods of activity that may occur many years apart, with a short course of steroids required. Three of these patients have undergone further vascular procedures during follow-up. We believe that a majority of these aneurysms can be managed surgically without the use of circulatory arrest. Long-term follow up is required to detect pseudoaneurysm formation and development of other vascular lesions.

	References

Top References

 

1. Botí ET, González IM, Bahamonde JA, León JM, Otero-Coto E. Deep hypothermia and circulatory arrest for surgery of high extracranial internal carotid aneurysm Ann Thorac Surg 2005;79:1767-1769.[Abstract/Free Full Text]
2. Tabata M, Kitagawa T, et al. Extracranial carotid aneurysm in Takayasu's areterits J Vasc Surg 2001;34:739-742.[Medline]
3. Odero A, Regina G. Letters to the editorregarding "extracranial carotid aneurysm in Takayasu's arteritis.". J Vasc Surg 2002:201.

This article has been cited by other articles:

				E. T. Boti and E. O. Coto Reply. Ann. Thorac. Surg., May 1, 2006; 81(5): 1943 - 1944. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sanjay Theodore Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Theodore, S. Articles by Neelakandhan, K. S. Search for Related Content PubMed PubMed Citation Articles by Theodore, S. Articles by Neelakandhan, K. S. Related Collections Peripheral vascular Related Article