Extracranial Carotid Artery Aneurysms: Long-term Results of Open Repair

Objective: Extracranial carotid artery aneurysms (ECA) are rare but the potential risk of rupture or thromboembolism argues for early treatment. Our goal was to determine complications and long term outcome of open surgical repair.
Methods: Retrospective review of clinical data of patients treated for ECA at our institution between 1990 and 2009.
Results: Twenty-seven patients, 13 females, 14 males (mean age 65 years) underwent treatment for ECA (mean size 3.9 cm, range: 1.2 to 6.5 cm). Etiology was pseudoaneurysm after prior carotid surgery (37%), fibromuscular dysplasia (14%), trauma (19%), atherosclerosis (19%), infection (7%), and Marfan Syndrome (4%). All non-traumatic aneurysms (n=22) involved the internal carotid artery (ICA), and the 5 traumatic aneurysms involved the common carotid artery. Pulsatile neck mass was present in 16 patients (59%), an audible bruit was identified in 12 (44%), and 14 patients (56%) had documented pre-operative transient ischemic attack or stroke. Concomitant aneurysms were present in 9 patients (33%), most commonly involving the abdominal aorta. All patients underwent elective open surgical repair including resection (n=22) with interposition bypass grafting (50%), end to end primary repair (23%), or patch angioplasty (27%), carotid ligation (n=3), and aneurysmorrhapy (n=2). There were no perioperative deaths. One patient (3.7%) had a neurological embolic event with permanent visual field deficits. Transient cranial nerve injury occurred in 3 patients (14%), all associated with repeat surgery or high cervical lesions. During a mean follow-up of 7 years, no strokes, neurologic events, or recurrent aneurysms occurred, and 5 patients died of cardiac causes.
Conclusions: Open surgical repair of ECA can be accomplished with minimal morbidity and excellent long-term results. For most patients, open repair remains the gold-standard of treatment. Patients requiring redo surgery or with distal cervical lesions have increased risk of temporary nerve injury, and therefore may be a subgroup that would benefit from percutaneous treatment.