Transcervical Open Repair of Extracranial Internal Carotid Artery Aneurysm

My name is Dr. Miguel Angel Mendoza Romo-Ramirez. I am a resident of angiology and vascular surgery. Together with the Department of Angiology, we present the case of a carotid aneurysm, as well as its description of the surgical technique. A 66-year-old male with a history of hypertension and diabetes presents in an angiology consultation with a pulsating mass in the left neck of one-year duration without pain or focal signs. Angiotomography was performed, and the left internal carotid artery was found with a saccular type of aneurysm, limited of the proximal position of the bifurcation. Open surgery is feasible when the aneurysm is limited to the proximal third in the internal carotid artery. It is essential to carry out surgical planing through imaging study, as well as knowing anticipated scenarios, carry out delicate handling of tissues to reduce the risk of bleeding. During the postoperative period, continuous arterial monitoring is vital to guarantee adequate perfusions and neurological monitoring, as well as close communication with the anesthesiologist. Adequate surgical exposure is carried out. The incision is made by plane until the aneurysm is identified, exposing the internal, external, and common left carotid artery. Abundant fibrosis is adjacent tissues is observed to the inflammatory reaction of the aneurysm. Additionally, displacement of the structures to the aneurysm, anastomosis of the proximal external carotid, with the distal internal carotid was performed, obtaining an exclusion of the aneurysm and interposition of the external carotid. Verified flows and hemostasis for the subsequent closed biplanes and ending the surgical event.

In the postsurgical management, the patient is moved to intensive care area and hospitalization observation. The patient is always neurologically intact. The previous medical management was vital, as well as the analgesic management and the subsequent antihypertensive control. Patient, he received, in outpatient clinic, after one month with controlled angiotomography with integrity of vascular structures, as well as presenting to consultation, walking and neurologically intact. Thanks to the entire JOMI team that makes the dissemination and editing of this case possible, as well as the staff who worked on the platform and to continue learning together.