| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2006;81:1943-1944
© 2006 The Society of Thoracic Surgeons
Service of Cardiovascular Surgery, Hospital Clínico Universitario, Valencia, 46010 Spain
(Email: otero_edu{at}gva.es).
We thank Dr Theodore and colleagues [1] for their interest in our report [2]. They present 4 patients with aneurysms of the internal carotid arteries, in addition to other cases involving the common and external carotid, with a mean age of 28 years. Most of these patients had Takayasu's arteritis, although the exact numbers are not provided. There are marked regional differences in the incidence of some types of pathology. Although rare in our countries, Western physicians should remember that carotid aneurysms can be seen in young patients and that in addition to atherosclerosis, trauma, dissection, and congenital diseases of the arterial wall, other causes are common in some parts of the world, including HIV-related arteritis, tuberculosis, syphilis, and some types of vasculitis, such as Takayasu's and Behçet disease.
Takayasu's arteritis is usually considered an obstructive form of arterial disease with predominant involvement of proximal arteries, but some cases have only aneurysms [3, 4], and the pathology may occasionally extend into the intracranial vessels [5]. Aneurysms in Takayasu's arteritis are frequently multiple, associated with stenotic lesions, and are mostly found in the aorta, with less common involvement of brachiocephalic arteries. Our patient [2] did not have any of the major or minor criteria for diagnosis of Takayasu's arteritis (other than the sometimes considered obligatory criteria of young age), nor did he have such criteria develop after 6 years of follow-up.
Several methods for surgical treatment of aneurysms of the high internal carotid artery have been successful, whether for aneurysms restricted to the infratemporal fossa or for large aneurysms extending through several segments of the internal carotid artery and reaching the skull, in which no distal control is possible. We showed that the cardiac and cardiovascular surgeon may treat these patients adequately by using deep hypothermia and circulatory arrest without the use of complex otological techniques. If the aneurysm is partially thrombosed, particularly if the thrombus is supposed to be recent, then avoiding manipulation of the aneurysm seems advantageous. Also by avoiding dissection of the internal wall of the aneurysm, the cranial nerves can be preserved thus providing a superior result.
Most carotid aneurysms found in Takayasu's arteritis are proximal, frequently affecting the common carotid instead of the internal carotid, and their size is usually small. In these situations we would never use deep hypothermia with circulatory arrest. We believe it is very important to exactly describe the location of carotid aneurysms using classifications such as the one proposed by Rosset and colleagues [6], because topography has a great influence on the surgical technique and incidence of some complications.
The risk of stenosis or pseudoaneurysm development in the follow-up of patients with aneurysms associated to Takayasu's disease has been well documented in the literature, as supported by Theodore and colleagues [1]. Suture lines should not be placed in diseased segments to avoid these complications. Endovascular repair may be a superior form of therapy for these patients, but it has not been adequately proved thus far, and in the presence of fresh thrombus, this could be a particularly risky procedure.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
