- Incidence
- Rare, accounting for 0.4–4% of aortic arch vessel aneurysms.
- Causes
- Degenerative disease/atherosclerosis (most common, often with hypertension), trauma (blunt, penetrating, or iatrogenic), arteritides (e.g., Takayasu arteritis, Behcet disease), connective tissue disorders (e.g., Marfan, Ehlers-Danlos), radiation injury, fibromuscular dysplasia, and infection.
- Presentation:
- More likely symptomatic compared to other arch vessel aneurysms (14–43% symptomatic).
- Symptoms:
- Pain (expansion or rupture).
- Cranial nerve palsy or Horner syndrome from compression.
- Dyspnea from tracheal compression.
- Neurologic deficits (amaurosis fugax, TIA, stroke) from thromboembolism.
- Proximal aneurysms are too deep to palpate; distal ones may be palpable or associated with a bruit.
- Diagnosis:
- CT angiography is the preferred diagnostic method, providing details on aneurysm size, thrombus burden, and anatomical relationships.
- MR angiography is an alternative, and any ultrasound-identified aneurysm should be further evaluated with advanced imaging.
- Management :
- Indications for Repair:
- All common carotid artery aneurysms should be repaired due to the high risk of embolic stroke.
- Nonoperative observation is associated with unacceptable morbidity and mortality.
- Open Surgical Repair
- Standard treatment, requiring exposure via Median sternotomy.
- Preferred graft: Prosthetic (PTFE) for proximal aneurysms; autogenous vein graft for distal aneurysms or those involving the bifurcation.
- Endovascular Repair:
- Less invasive, avoiding sternotomy, but requires favorable anatomy (adequate proximal and distal seal zones).
- Covered nitinol stents (balloon-expandable or self-expanding) are used selectively.
- Clinical outcomes from open, endovascular, and hybrid approaches are generally good, as demonstrated in meta-analyses