Supra-aortic vessels aneurysms: Diagnosis and prompt intervention
Received 19 June 2008; accepted 27 August 2008.
Purpose
Aneurysms involving the supra-aortic vessels are rare but carry serious risk of embolization, thrombosis, and rupture. We describe our experience with the diagnosis, treatment strategies, and outcomes in patients with extended follow-up.
Methods
Data during a 17-year period (January 1990 to December 2007) was analyzed. We assessed age, gender, presenting symptoms, localization, pathologic diagnosis, type of procedures, complications, and survival.
Results
A total of 74 patients were treated for supra-aortic aneurysms. Of all aneurysms treated, 63% were degenerative, 24% iatrogenic, 8% traumatic, 3% genetic, and 1% mycotic. The subclavian artery was most commonly affected (50%, 2/3 in the right side), followed by the common carotid (36%), internal carotid (10%), innominate (3%), and vertebral (1%). At the time of diagnosis, 52 patients (70%) were asymptomatic, but of those symptomatic 68% had an embolic event as a presenting symptom. Embolic episodes were more common in patients with smaller aneurysms (P < .006). Open surgery was performed in 77% of all cases, and the use of endovascular techniques became the predominant treatment modality over the last 4 years. Survival at 30 days was 100%. Five- and 10-year survival rates were 87% and 43%, respectively.
Conclusion
Most cases of supra-aortic aneurysm are asymptomatic and embolization as opposed to rupture represents the greatest risk to the patient. Most cases can be detected prior to symptoms. Endovascular repair is an emerging alternative of treatment and, with the current development of appropriate devices, will likely form the mainstay of therapy in the near future.
aDepartment of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
bDepartment of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
cDepartment of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
Correspondence: Roy K. Greenberg, MD, S40, Department of Vascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195
ABSTRACT