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Idiopathic multiple aneurysm of external carotid artery.
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MedLine Citation:
PMID:  25161978     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Aneurysms of external carotid artery are rare. Treatments for these are undertaken for the prevention of complications like hemorrhage or rupture, and embolism. We present a 71-year-old male with idiopathic multiple aneurysm for the past 34 years on conservative management and regular follow up for the past 4 years. This case was discussed for the rarity of idiopathic multiple aneurysm of the external carotid artery and the need for individualized treatment protocol to be followed as in this case, only watchful observation considering the age and patient compliance. In this world of evolving surgical techniques and newer treatment modalities, conservative treatment still has a role to play. Primary care physicians at the community level have a major role in following these patients and referring them as and when the need arises.
Authors:
Saravanan Balachandran; Rathinavel Subrammaniyan; Ashok Kumar; Lakshmi Dharan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of family medicine and primary care     Volume:  3     ISSN:  2249-4863     ISO Abbreviation:  J Family Med Prim Care     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-08-27     Completed Date:  2014-08-27     Revised Date:  2014-08-29    
Medline Journal Info:
Nlm Unique ID:  101610082     Medline TA:  J Family Med Prim Care     Country:  India    
Other Details:
Languages:  eng     Pagination:  164-5     Citation Subset:  -    
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Journal Information
Journal ID (nlm-ta): J Family Med Prim Care
Journal ID (iso-abbrev): J Family Med Prim Care
Journal ID (publisher-id): JFMPC
ISSN: 2249-4863
ISSN: 2278-7135
Publisher: Medknow Publications & Media Pvt Ltd, India
Article Information
Copyright: © Journal of Family Medicine and Primary Care
open-access:
Print publication date: Season: Apr-Jun Year: 2014
Volume: 3 Issue: 2
First Page: 164 Last Page: 165
PubMed Id: 25161978
ID: 4140001
Publisher Id: JFMPC-3-164
DOI: 10.4103/2249-4863.137667

Idiopathic Multiple Aneurysm of External Carotid Artery
Saravanan Balachandranaff1
Rathinavel Subrammaniyanaff1
Ashok Kumaraff1
Lakshmi Dharanaff1
Department of Vascular Surgery, Government Stanley Medical College, Chennai, Tamil Nadu, India
Correspondence: Address for correspondence: Dr. Saravanan Balachandran, Plot no. 63, Kesari Nagar, Adambakkam, Chennai - 600 088, Tamil Nadu, India. E-mail: saaravanan@gmail.com

Introduction

Carotid artery aneurysm are rare. Etiologies include injury, tumor of head and neck and rasiation therapy. These lesions though may cause life threatening hemorrhage, watchful observation is still considered as a treatment option in these patients.


Case Report

A 71-year-old male presented with pulsatile swelling over the right side of face and over the forehead in october 2009. The swelling has been there for the past 34 years. Patient denies history of trauma, transient ischemic attack, headache, or giddiness. Patient is a known diabetic and hypertensive for the past 9 years on regular medications.

Patient was evaluated with computed tomography (CT) angiogram, which showed aneurysm of the external carotid artery with thrombus within and multiple aneurysm of the branches of external carotid arteries.

Treatment[1] option of excising the aneurysm with ligation of external carotid aneurismal branches was discussed with the patient. Since the swelling was asymptomatic for the past 34 years, patient was not willing for any procedure.[2, 3, 4, 5]

The patient has been advised to come for regular follow up every 6 months. He is assessed with clinical examination on each visit and ultrasound examination performed once in a year to assess the size of the aneurysm.

The patient has been on follow up for the past 4 years without any new symptoms or increase in size of the aneurysm.


Discussion

Aneurysm of the external carotid artery and its branches have been described in cases due to trauma, iatrogenic injury, dental extraction, and also due to head and neck cancer because of tumor infiltration or due to radiation therapy.[2]

Geriatric patients with aneurysm are first consulted by a primary care physician and hence primary care physician at the community level has a major role in following these patients and referring these patients to specialized vascular centre. Increase in size of the aneurysm or impending rupture necessitates the need for referral to specialized center. The need for surgical intervention or endovascular stenting does not arise in our patient who has this aneurysm for 34 years and was on follow up for the past 4 years without any symptoms [Figure 1].

In this setting, the role of primary care physician is important to decide upon surgical or conservative management after having discussion with the patient. Conservative management[6] can be offered as treatment in such cases [Figure 2].

This case was discussed for the rarity of idiopathic multiple aneurysm [Figure 3] of the external carotid artery [Figure 4] and the need for individualized treatment protocol to be followed, as in this case, only watchful observation.[6] In this world of evolving surgical techniques and newer treatment[2, 3, 4] modalities, conservative treatment still has a role to play.


Conclusion

Even in the era of advanced medical technology[3, 4, 5] practices, treatment should be individualized and the choice rests with the patient. Primary care physicians have a major role in follow up of these patients and decide upon referring these patients to specialized vascular center thus lessen the burden of vascular centre in following these patients.


Notes

Source of Support: Nil.

Conflict of Interest: None declared.

References
1. Chen G,Leng B,Song D,Wang Q. Multiple aneurysms of internal and external carotid arteriesActa Neurol BelgYear: 2010110120120514942
2. Fitzpatrick D,Gandras EJ,Greben CR,Restrepo G,Avi S. Embolization of an External Carotid Artery Mycotic AneurysmEndovascular TodayYear: 20096163
3. Mukherjee D,Roffi M,Yadav JS. Endovascular treatment of carotid artery aneurysm with stent graftsJ Invasive CardiolYear: 2002142697211983950
4. Nadig S,Barnwell S,Wax MK. Pseudoaneurysm of the external carotid artery-review of literatureHead and NeckYear: 2009Vol. 31Maiden MA, USAJohn Wiley and Sons Inc136918642284
5. Simionato F,Righi C,Melissano G,Rolli A,Chiesa R,Scotti G. Stent-graft treatment of a common carotid artery pseudoaneurysmJ Endovasc TherYear: 200071364010821100
6. Grigoryants V,Eagleton MJ,Upchurch GR Jr. Bilateral external carotid artery aneurysmVascularYear: 200412387915895763

Figures

[Figure ID: F1]
Figure 1 

Pulsatile swelling over the face, forehead, and scalp



[Figure ID: F2]
Figure 2 

Multiple aneurysm of external carotid artery



[Figure ID: F3]
Figure 3 

Aneurysm of the branches of external carotid artery



[Figure ID: F4]
Figure 4 

Cross section showing thrombus within the aneurysm



Article Categories:
  • Case Report

Keywords: Aneurysm, angiogram, external carotid artery, hemorrhage.

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