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Ica  aneurysm
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Ica aneurysm

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Transcript

  • 1. Case study
  • 2. Case  16 years male presented with complaints of dizziness associated with transient loss of vision ? in the right eye over the past one month
  • 3. Diagnosis ?
  • 4. History ?
  • 5.  Any neurological deficit  Trauma  Any surgery  Fever, joint pain ?
  • 6. Examination ?
  • 7.  Swelling  Pulsatile mass  Oral cavity  Carotid bruit  Horner’s syndrome
  • 8. Complication ?
  • 9.  Thromboembolism  Neurological complications  Rupture
  • 10. Management ?
  • 11.  Surgical reconstruction  Endovascular treatment
  • 12. Complication ?
  • 13.  Thrombosis  Endoleak  Perforation  Migration  Infection  Dissection of artery
  • 14. Carotid Artery Aneurysm
  • 15. Introduction  Aneurysm of extracranial carotid artery (ECAA) is an uncommon but important clinical entity  Incidence of intracranial carotid artery aneurysm (0.8 – 18 %) and ECAA is 1- 1.5 %  ECAA is less than 1 % of all carotid pathologies
  • 16. Definition  The accepted difinition of most arterial aneurysm is 50 % increase in diameter compared to the normal diameter of artery.  But in case of carotid bifurcation diameter should be 200 % more than ICA / 150 % of CCA
  • 17. Etiology  Degenerative / Atherosclerosis  Post traumatic causes  Postendarterectomy  Vasculitis  Connective tissue disorder  Mycotic Aneurysm /SABE
  • 18. Clinical features  Pulsatile mass  Painful ,tender mass , fever  Neurological symptoms  Cranial nerve dysfunction  Dysphagia  Hemorrhage and rupture
  • 19. Differential diagnosis  Tortuous , kinked /coiled carotid artery  Prominent carotid bifurcation  Cervical lymphnodes overlying the carotid bifurcation  CBT  Cervical metastatic disease  Branchial cyst  Cystic hygroma
  • 20. Investigation  Duplex ultrasound – limitation ?  CTA ; Advantages ;bony anatomical landmark ;circle of willis ; brain imaging
  • 21. Treatment  Surgical Reconstruction  Endovascular
  • 22. Advantage  Avoiding difficult dissection  Proximal control is difficult  Reduce the risk of cranial nerve injuries  CONTRAINDICATION  Unstable Thrombs  Very tortuous carotid arteries
  • 23. Post procedure  Surgical reconstruction ; Aspirin  Endovascular treatment ; clopidogrel : Aspirin * Statins
  • 24.  Form 2010 – 2013 we have total 29 cases  Out of them 18 have surgical reconstruction  11 have endovascular procedure
  • 25. European journal of vascular & endovascular surgery  From Jan 1998 to Dec 2011 ,50 consecutive interventions for ICA aneurysmal disease was performed  3 patients developed major stroke  6 patients had cranial nerve injuries  3 patients had Thrombosis  Conclusion; surgical treatment provided satisfactory early & long term result,selected patients with non infected aneurysm endovascular option seems to be feasile
  • 26. Reference Otolaryngology head & neck surgery ; Charles W. Cummings Surgery of the chest ; Sabiston & Spencer
  • 27. Thank you