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BMJ Case Reports 2013; doi:10.1136/bcr-2012-007705
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Extracranial saccular atherosclerotic aneurysm of the internal carotid artery (ICA) treated by an oblique end-to-end primary anastomosis

  1. Louis Fligelstone4
  1. 1Radiology Department, Cardiff and Vale University Health Board, Cardiff, UK
  2. 2General Medicine Department, Hywel Dda Health Board, Llanelli, UK
  3. 3Vascular Surgery Department, Hywel Dda Health Board, Carmarthen, UK
  4. 4Vascular Surgery Department, ABM University Health Board, Swansea, UK
  1. Correspondence to Jakub Kaczynski, jakub.kaczynski{at}hotmail.co.uk

Description

A 67-year-old woman presented with a 3-month history of a pulsatile mass on the right side of the neck and a hoarse voice. She did not report any neurological symptoms, and there was no history of trauma, infection or any previous surgical intervention. There was no medical history and the patient was a non-smoker. Physical examination revealed a pulsatile mass below the right angle of mandible with some discomfort along the mandible. CT angiogram (CTA) showed an elongated and tortuous internal carotid artery (ICA) with 180° bend before the formation of 2.7 cm saccular (anteroposterior diameter) aneurysm (figure 1). Subsequently, a total aneurysmectomy with end-to-end oblique anastomosis under a general anaesthesia was performed (figure 2). Overall the patient made an uneventful postoperative recovery. Histopathology confirmed the presence of a true atherosclerotic saccular aneurysm with no evidence of vasculitis or active inflammation (figure 3).

Figure 1

Right internal carotid artery aneurysm.

Figure 2

End to end oblique primary anastomosis.

Figure 3

Saccular atherosclerotic internal carotid artery aneurysm.

Aneurysms of the extracranial portion of carotid arteries are rare. Their reported incidence is about 0.8–1%, and they comprise less than 5% of all …

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