Atherosclerotic saccular aneurysm of the extracranial internal carotid artery: Surgical repair

Introduction and importance: Extracranial carotid aneurysms (ECCAs) are relatively uncommon. Most of these lesions are due to atherosclerosis, trauma, infection, radiotherapy, previous surgery or iatrogenic event. Severe complications include rupture, dysphagia, respiratory symptoms and brain embolization. Case presentation: We report a case of a large saccular aneurysm of the extracranial internal carotid artery (EICA) in a 83-year old asymptomatic woman without any apparent causative history. The patient underwent a successful repair of the aneurysm by aneurysmectomy and primary end-to-end anastomosis between the proximal and distal portion of the remaining vessel with continuity restored without tension. Clinical discussion: ECCAs are rare with few cases reported in the most recent literature. There is little knowledge of their natural history and management. Both surgical and endovascular as well as medical treatments have been recommended depending on disease-location and comorbidities. Conclusion: Although treatment should be individualized time by time by evaluating patient's characteristics, the surgical repair could be a safe and effective solution to treat distal EICAs, especially for symptomatic and true growing lesions. The presentation, the diagnostic evaluation, and the successful surgical treatment are discussed.