Chapter 94 - Carotid artery aneurysms

Question 1

Incidence of extracranial carotid aneurysms

Answer 1

0.8-18% in autopsy

<1% of all carotid diseases

Question 2

Normal carotid bifurcation size in relation to ICA

Answer 2

40% greater in diameter than ICA

Question 3

Definition of carotid artery aneurysm

Answer 3

1) bulb > 200% ICA or

2) ICA > 150% of CCA

Question 4

first carotid aneurysm operation

Answer 4

1806, 1808 Astley Cooper

ligation of CCA

Question 5

Mortality of carotid ligation

Answer 5

28% historically

now more like 12%

Question 6

first resection of carotid aneurysm with anastamosis primary

Answer 6

Dimitza 1952

Shea 1955 - first report

Question 7

first prosthetic graft replacement of carotid aneurysm

Answer 7

Beall 1959

Question 8

Mycotic carotid aneurysms

Answer 8

reduced frequency over years

1) syphilis
2) TB
3) middle ear infection
4) tonsillar infection
5) immunosuppression HIV

Question 9

Contemporary causes of carotid aneurysms

Answer 9

1) atherosclerotic degen 36%
2) dissection 6%
3) trauma 13%
4) previous carotid surgery
5) radiation
6) pseudoaneurysm 33%
7) FMD 7%
8) infection 2%

Question 10

Rate of bilateral carotid aneurysm

Answer 10

5%

Question 11

gender difference degenerative carotid aneurysms and age

Answer 11

male > women 2:1

> 60 years old

Question 12

Connective tissue disorders related to carotid aneurysm

special surgical consideration

Answer 12

1) EDS4
2) neurofibromatosis
3) Behcet

prosthetic conduits instead of vein due to high risk of psuedoaneurysm development

Question 13

Post CEA aneurysm causes

Answer 13

1) suture line failure
2) infection
3) vein patch degeneration

Question 14

Organism in CEA aneurysm infection

Answer 14

Staph

Question 15

Cause for inward protrusion of ICA aneurysms

Answer 15

1) deep cervical fascia and muscles on styloid anteriorly
2) cervical vertebrae posteriorly
3) dilation towards tonsillar fossa

Question 16

Symptoms of carotid aneurysm

Answer 16

1) painless pulsatile mass 93%
2) neurological deficits 43%
3) dysphagia

Question 17

Cranial nerve dysfunction with carotid aneurysm

Answer 17

1) Horner
2) Vagus - recurrent laryngeal
3) facial - pain
4) trigeminal
5) abducens

Question 18

Most common cause of a pulsatile neck mass

Answer 18

Tortuous or kinked carotid artery

Question 19

Differential for pulsatile neck mass

Answer 19

1) cervical lymph node over artery
2) carotid body tumors
3) glomus jugulare tumors
4) cervical metastatic disease
5) brachial cleft cysts
6) cystic hygromas

Question 20

Balloon occlusion test

Answer 20

1) 30 min time
2) stump pressure measurement (>50% of systemic pressure indicates adequate flow)
3) assess pt clinically

inaccurate 10-20% of time

Question 21

Fankhauser Mayo Clinic on conservative mgnt of carotid aneurysm

Answer 21

None progressed to need treatment after 77 months

Size of aneurysm
12mm vs 21.2mm (got treated)

size of pseudoaneurysm
10.2 mm vs 20.9mm got treated

Question 22

Indication to treat carotid aneurysms

Answer 22

1) > 2cm
2) mycotic
3) thrombus in aneurysm
4) symptomatic
5) enlarging aneurysm on imaging

Question 23

Cranial nerve injury rate after complete excision of carotid aneurysm

Answer 23

4-20%

Question 24

Patch type and pseudoaeurysm formation

Answer 24

1) most due to infection

2) one series pointed towards dacron patches

Question 25

Endovascular options for treating carotid aneurysm

Answer 25

1) bare stent
2) bare stent with coiling
3) double stent
4) autogenous vein-graft covered stents
5) endo coil
6) covered stents

generally results favorable if anatomy suitable

Question 26

El-Sabrout and Cooley data on carotid aneurysm
non-op
ligation
reconstruction

death/stroke rate

Answer 26

non-op 21%
ligation 12%
recon 9%

Question 27

Carotid blowout

Answer 27

due to degeneration of carotid artery with previous cancer treatment or surgery
vasovasorum damage, adventitial skinning

Question 28

Mycotic aneurysm organism

Answer 28

1) gram positive: staph aureus and epi

2) Gram negative: E coli, Klebsiella, corynebacterium, proteus, yersinia