Angiletta Domenico, Pulli Raffaele, Marinazzo Davide, Frotino Pietro, Maiellaro Luisa, Regina Guido
Department of Vascular Surgery, University of Bari "Aldo Moro", Bari, Italy.
Department of Vascular Surgery, University of Florence, Florence, Italy.
Ann Vasc Surg. 2014 Apr;28(3):659-64. doi: 10.1016/j.avsg.2013.05.014. Epub 2014 Jan 31.
To evaluate early and long-term results of surgical and endovascular therapy of extracranial carotid artery aneurysms.
A retrospective study was conducted of 26 aneurysms in 25 patients (19 men and 6 women) who underwent surgery between 1993 and 2010: 18 were atherosclerotic, 3 were from arteritis, 1 was a relapsing mycotic aneurysm from previous carotid surgery, and 4 were posttraumatic. A neurologic event was the presenting symptom in 10 cases (7 transient ischemic attacks, 3 strokes); 13 patients were asymptomatic and a cranial nerve dysfunction (hoarseness) was present in 2; fever was present in 1. A total of 15 aneurysms, located on the carotid bifurcation (CB), were resected and an end-to-end carotid anastomosis was performed. In 6 patients with CB aneurysms, a vein graft was applied in 5, and a polytetrafluoroethylene graft in the other. Aneurysmorrhaphy and a vein patch was the procedure in 2 patients with an aneurysm of the CB. One of these 2 patients had a relapsing mycotic pseudoaneurysm and was treated initially with a vein patch, subsequently with a vein graft, and lastly with a carotid artery ligation. Three common carotid artery aneurysms from arteritis were treated under local anesthesia through implantation of a Viabahn endoprosthesis.
A perioperative minor stroke occurred in 1 patient (3.8%) because of intentional ligation of the internal carotid artery from a relapsing mycotic aneurysm, already treated with a vein patch and subsequently with a vein bypass. No permanent cranial nerve injuries were recorded; transient cranial nerve injuries were observed in 2 patients.
Surgical treatment is feasible, with an acceptable rate of stroke and cranial nerve injuries, especially when the aneurysm is located on the common carotid artery and carotid bulb. Endovascular therapy is a fascinating option, with satisfactory early and long-term results, and should always be considered when treating aneurysms located in the distal internal carotid artery and when the patient is not a good candidate for open surgery.
评估颅外颈动脉动脉瘤手术及血管内治疗的早期和长期效果。
对1993年至2010年间接受手术的25例患者（19例男性，6例女性）的26个动脉瘤进行回顾性研究：18个为动脉粥样硬化性，3个源于动脉炎，1个是既往颈动脉手术后复发的霉菌性动脉瘤，4个为创伤后动脉瘤。10例患者以神经系统事件为首发症状（7例短暂性脑缺血发作，3例中风）；13例患者无症状，2例存在颅神经功能障碍（声音嘶哑）；1例发热。共15个位于颈动脉分叉（CB）处的动脉瘤被切除，并进行了颈动脉端端吻合术。6例CB动脉瘤患者中，5例应用了静脉移植物，另1例应用了聚四氟乙烯移植物。2例CB动脉瘤患者采用了动脉瘤缝合术及静脉补片修补术。这2例患者中有1例为复发性霉菌性假性动脉瘤，最初采用静脉补片治疗，随后采用静脉移植物，最后进行了颈动脉结扎。3例动脉炎所致的颈总动脉瘤在局部麻醉下通过植入Viabahn血管内支架进行治疗。
1例患者（3.8%）因复发性霉菌性动脉瘤行颈内动脉故意结扎（该动脉瘤已先后采用静脉补片和静脉搭桥治疗）发生围手术期轻度中风。未记录到永久性颅神经损伤；2例患者观察到短暂性颅神经损伤。
手术治疗是可行的，中风和颅神经损伤发生率可接受，尤其是当动脉瘤位于颈总动脉和颈动脉球部时。血管内治疗是一个有吸引力的选择，早期和长期效果令人满意，在治疗位于颈内动脉远端的动脉瘤以及患者不适合开放手术时应始终予以考虑。
