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  • • Rare

    • May occur anywhere along extracranial portion

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Epidemiology

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True Aneurysms

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  • • Caused by

    • -Atherosclerosis

      -Occasionally by cystic medial necrosis, Marfan syndrome, or fibromuscular dysplasia

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False Aneurysms

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  • • Occur rarely after carotid endarterectomy

    • Occur as result of trauma, or infection (pharyngeal abscess)

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Symptoms and Signs

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  • • Pulsatile neck mass

    • Dysphagia can occur from protrusion into oropharynx

    • Neck pain, radiating to jaw

    • 30% present with transient ischemic attacks

    • Rupture (more common with false aneurysms) into oropharynx, ear canal, soft tissues of neck

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Imaging Findings

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  • Duplex US: Initial test

    • Arteriography necessary to plan surgery

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  • • Duplex US will differentiate redundant carotid artery from aneurismal and identify occlusive disease

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Rule Out

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  • • Coiled or redundant carotid artery, subclavian artery (can present as pulsatile neck mass)

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  • • Duplex US

    • Angiography prior to surgery

    • Consider CT if infection or traumatic

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  • • If accessible, resect and replace aneurysm with graft or vein

    • Endovascular stenting may be an option

    • False aneurysms should be repaired

    • Can ligate extensive aneurysm if back pressure > 65 mm Hg

    • -Can identify potential candidates with awake arteriography and balloon occlusion

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Surgery

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Indications

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  • • True or false aneurysm

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Prognosis

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  • • Good if repairable

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Preferences

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  • • El-Sabrout R et al. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg. 2000;31:702.

    • Rosset E et al. Surgical treatment of extracranial internal carotid artery aneurysms. J Vasc Surg. 2000;31:713.

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