An interesting case of Bilateral Carotid aneurysms

Arunagiri Viruthagiri*, Nedounsejiane Mandjini, Arunprasath S

Vascular Surgeon, Kauvery Hospital, Trichy, India

Background

Aneurysms of the carotid artery are rare with multiple underlying etiologies. Treatment is largely open surgery but medical and endovascular therapies have been used based on presentation, anatomy, and etiology. Here we present a case of bilateral saccular carotid aneurysms where we have operated on the symptomatic side.

Case Presentation

A 55-year-old housewife presented to us with pain on the left side of neck. She has been blind and has no children. She looks after her husband. She was evaluated outside and diagnosed to have carotid aneurysm and referred to us.

Clinical Evaluation

She had a pulsatile swelling on both sides of her neck. She was evaluated for infective endocarditis, which is a common cause of infected aneurysm, which turned out to be negative. After a thorough preoperative evaluation, she was taken up for aneurysm repair on the left side which had thrombus and was symptomatic.

Fig. 1. Bilateral multiple saccular carotid aneurysms.

Operative repair

We did a complete excision of three saccular aneurysms and did an Internal Carotid Artery (ICA) end-to-end anastomosis as it was redundant. ICA clamp time was 15 min. She didnâ€™t have any neurological deficit in the postoperative period. She developed a hematoma on POD 1 with tracheal deviation. We did an emergency exploration and hemostasis was secured. She made an uneventful recovery.

Fig. 2. Aneurysm adherent to carotid bifurcation.

Fig. 3. Thrombus inside the aneurysm.

Fig. 4. Post ICA anastomosis.

Fig. 5. After closure.

Follow up

At 3 weeks she is doing well with no hoarseness of voice, and with no neurological deficit. She has difficulty in swallowing which is getting better. She is planned for surgery on the right side at 3 months.

Discussion

Aneurysms are a rare pathology of the carotid arteries. It is estimated that 0.1 to 2% of all carotid procedures are performed for aneurysm disease. It also only accounts for 0.4 to 4% of all peripheral artery aneurysms. They pose a significant problem in regards to potential for neurologic complications and many are first recognized secondarily to stroke or transient ischemic attack. Open surgical approaches vary depending on anatomy and underlying pathology. These can include: ligation, resection with primary repair, resection with interposition graft, resection with patch repair of the artery. Treatment is tailored to the individual patient without one specific type of treatment recommended for all carotid aneurysms.

Acknowledgement

Anesthetic team: Dr. P Senthilkumar, Dr. Nirmal kumar; Surgical assistance: Dr. Anis; Preoperative Evaluation: Dr. Dominic Rodriguez, Dr. Anand Subrammaniyam; Photographs: Mr. Nandakumar.

References

[1] Kraemer CJK, Zhou W. Carotid aneurysm review-Int J Angiol. 2019;28(1):17-9.

An interesting case of Bilateral Carotid aneurysms