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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES VASCULAR PAPERS
The Journal of Cardiovascular Surgery 1999 February;40(1):21-6
Elongation of the internal carotid artery and abdominal aortic aneurysm: Is there a relationship?
Ballotta E., Da Giau G., Bottio T.
From the Vascular Surgery Section 1st Institute of General Surgery University of Padua, School of Medicine, Padua, Italy
Background. This study was undertaken to analyze whether there is a relationship between the elongation of the internal carotid artery (e-ICA) and abdominal aortic aneurysm (AAA).
Methods. Forty-three patients had concomitant evidence of an asymptomatic AAA and e-ICA: all of these patients underwent surgical AAA repair, while 25 (58.1%) also underwent surgical e-ICA correction. The 43 patients were compared with a control group of 141 e-ICA subjects with no AAA as regards to age, gender, risk factors and associated diseases. An operative specimen of the aneurysmal wall was obtained in 32 instances (74.2%); an operative specimen of the carotid wall was obtained in 100% of operations.
Results. The overall perioperative mortality rate was 0%. Patency of the revascularized ICA was assured in 100% of cases. The perioperative stroke risk rate was 0%. The perioperative morbidity rate for abdominal surgery was 6.9% (3/43). There were three late deaths: one patient died from a major stroke due to occlusion of the unoperated e-ICA. Degenerative dysplastic changes were observed in the tunica media in all carotid specimens; non-obstructive atherosclerotic intimal lesions were superimposed in a few cases. Histological features of “classic” AAA, i.e. thinning of the tunica media underlying the atherosclerotic plaque, were discovered in all but five aortic wall specimens.
Conclusions. The association between e-ICA and AAA is stronger than one would expect from atherosclerosis alone and should not be ignored. A primary arterial disorder of the tunica media seems to lie at the basis of both conditions, so patients with e-ICA should be investigated and followed up for any occurrence of AAA and, vice versa, patients with AAA should be investigated for any presence of e-ICA. On the basis of the results obtained, surgical repair of both conditions is recommended in selected patients.