Asian Cardiovasc Thorac Ann 2008;16:185-186
© 2008 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Bilateral Common Carotid Artery Aneurysm in Takayasu’s Arteritis
Masato Tochii, MD,
Motomi Ando, MD,
Mitsuru Yamashita, MD,
Koji Hattori, MD,
Ryo Hoshino, MD,
Kiyotoshi Akita, MD
Department of Cardiovascular Surgery Fujita Health University Aichi, Japan
For reprint information contact: Masato Tochii, MD, Tel: 81 562 93 9255, Fax: 81 562 93 7370, Email: masato26{at}fujita-hu.ac.jp, Department of Cardiovascular Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470–1192, Japan.
A 19-year-old male with Takayasu’s arteritis was referred to us due to the presence of a bilateral common carotid artery aneurysm. He had experienced dull pain in the right neck and positive inflammatory signs 2 years previously, at which time a diagnosis of Takayasu’s arteritis with bilateral common carotid artery aneurysms was confirmed. He had received steroid therapy, which controlled the inflammatory changes well. Surgical treatment was indicated for the right common carotid artery aneurysm due to the enlargement to the 35 mm, although 25 mm on the left side (Figure 1
). A further systemic examination revealed no other aneurysmal portion or stenotic lesion.
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Figure 1. Bilateral common carotid artery aneurysms visualized with three-dimensional computed tomography (a, b) and catheter angiography (c); the right subclavian artery was not evident in three-dimensional computed tomography due to pooling of the contrast medium therein (a, b).
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Under general anesthesia, the right common carotid artery was exposed. After systemic heparinization, the external and internal carotid arteries and the proximal portion of the aneurysm was cross clamped. The mean pressure in the right internal carotid artery distal to the clamp area was 50 mm Hg during the cross clamping. The aneurysm was incised and replaced via in-situ grafting with a polyester graft. There was a fresh clot inside the aneurysm (Figure 2). The left-side aneurysm was replaced in the same way 2 months later during his second admission because of the possible risk of cerebral infarction resulted in the fresh clot inside the aneurysm, although it was not so large.
Takayasu’s arteritis usually presents as an aneurysmal formation, stenotic changes or a combination of these clinical presentations in the aorta and its branches. Long-term careful observation is mandatory since a new aneurysm often forms at the previous suture line, with new aneurysms and obstructive disease occurring in the other aortic branches.
The patient with Takayasu’s arteritis usually had the long history of steroid therapy, which leads to thrombus formation inside the aneurysm. The early surgical intervention should be indicated even for relatively small aneurysm in the carotid artery, not only for the risk of rupture but also for the risk of cerebral infarction.
