Raffaele Pulli1, Walter Dorigo1, Alessandro Alessi Innocenti1, Giovanni Pratesi2, Aaron Fargion1, Carlo Pratesi1
1Vascular Surgery, University of Florence, Florence, Italy; 2University of Rome Tor Vergata, Rome, Italy.
OBJECTIVES: To retrospectively analyze early and late results of surgical management of internal carotid artery (ICA) true and false aneurysms in a single center experience
METHODS: From January 1988 to December 2011, 53 consecutive interventions for ICA aneurismal disease were performed; interventions were performed for true ICA aneurysm in 19 cases (group 1) and for ICA pseudo-aneurysm in the remaining 34 (31 post-endarterectomy -CEA- and post-traumatic in the remaining 3; group 2).
Early results (<30 days) were evaluated in terms of mortality, stroke and cranial nerves’ injury and compared between the two groups with χ2 test.
Follow-up results (stroke-free-survival, freedom from ICA thrombosis and reintervention) were analyzed with Kaplan-Meyer curves and compared with log-rank test.
RESULTS: All the patients in group 1 had open repair of their ICA aneurysm; in group 2 open repair was performed in 30 cases, while three patients with post-CEA aneurysm without signs of infection and one patient with post-traumatic pseudo-aneurysm had a cover stent placed.
There were no perioperative deaths. Two major strokes occurred in group 1 and one major stroke occurred in group 2 (p=0.3). The rates of postoperative cranial nerve injuries were 10.5% in group 1 and 14.5% in group 2 (p=0.6).
Median duration of follow-up was 60 months (range 1-276). Estimated 10-year stroke-free survival rates were 51% in group 1 and 39% in group 2 (p=0.7, log rank 0.1); thrombosis-free survival at 10 years was 53% in group 1 and 34% in group 2 (p=0.2, log rank 1.2), while the corresponding figures in terms of reintervention-free survival were 54% and 33%, respectively (p=0.2, log rank 1.8).
CONCLUSIONS: Surgical treatment of ICA aneurismal disease provided in our experience satisfactory early and long term results, without significant differences between true and false aneurysms. In selected patients with false aneurysm the endovascular option can be suggested.
AUTHOR DISCLOSURES: A. Alessi Innocenti, Nothing to disclose; W. Dorigo, Nothing to disclose; A. Fargion, Nothing to disclose; C. Pratesi, Nothing to disclose; G. Pratesi, Nothing to disclose; R. Pulli, Nothing to disclose.
Posted April 2012