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ORIGINAL ARTICLES  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 1999 February;40(1):21-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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