Carotid artery aneurysms in patients with human immunodeficiency virus

Objectives

Carotid artery aneurysms, although rare, are increasing in frequency due to their association with human immunodeficiency virus (HIV) disease. Our institution serves a population with a high HIV prevalence and we wished to document our growing experience with this aneurysmal pathology in a setting of an ever-increasing burden of HIV disease.

Methods

Data on all patients managed at Inkosi Albert Luthuli Central Hospital in Durban, South Africa, from July 2003 to December 2009 with HIV carotid aneurysms were extracted from a prospective vascular database and their case records were examined. Twenty-two patients were identified of whom 21 had preoperative imaging and underwent some form of intervention.

Results

The initial presentation in 19 of the 22 patients was a progressively enlarging neck mass and pain. Ten patients presented with neurology with only 1 patient presenting with a hemiplegia and 1 patient with a monoplegia. Sixteen patients had an open operative repair and 5 patients had an endovascular repair performed as the initial procedure. Of the open procedure, 8 patients had an interposition graft used and 8 had ligation of the common carotid artery (CCA), external carotid artery (ECA), and/or internal carotid artery (ICA). Eighteen patients had no immediate postoperative neurological complications. The worst outcomes were from patients who underwent an endovascular procedure. These included one death, two thrombosed stents, and one endoleak. Histology showed active tuberculosis (TB) in 6 patients who were not known to have TB preoperatively. The overall mortality was 3 of 22 patients.

Conclusion

We have noted aneurysms of the carotid artery to occur in patients who are infected with HIV and it seems to be that the incidence of such aneurysms is more common than documented. Open surgical intervention either in the form of an interposition graft or ligation seems to be the more effective treatment option as compared to endovascular stenting. Stenting should be reserved for those patients unfit for open surgery.