Journal of Family Medicine and Primary Care

CASE REPORT
Year
: 2014  |  Volume : 3  |  Issue : 2  |  Page : 164--165

Idiopathic multiple aneurysm of external carotid artery


Saravanan Balachandran, Rathinavel Subrammaniyan, Ashok Kumar, Lakshmi Dharan 
 Department of Vascular Surgery, Government Stanley Medical College, Chennai, Tamil Nadu, India

Correspondence Address:
Saravanan Balachandran
Plot no. 63, Kesari Nagar, Adambakkam, Chennai - 600 088, Tamil Nadu
India

Abstract

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.



How to cite this article:
Balachandran S, Subrammaniyan R, Kumar A, Dharan L. Idiopathic multiple aneurysm of external carotid artery.J Family Med Prim Care 2014;3:164-165


How to cite this URL:
Balachandran S, Subrammaniyan R, Kumar A, Dharan L. Idiopathic multiple aneurysm of external carotid artery. J Family Med Prim Care [serial online] 2014 [cited 2019 Sep 21 ];3:164-165
Available from: http://www.jfmpc.com/text.asp?2014/3/2/164/137667


Full Text

 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].{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].{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. {Figure 3}{Figure 4}

 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.

References

1Chen G, Leng B, Song D, Wang Q. Multiple aneurysms of internal and external carotid arteries. Acta Neurol Belg 2010;110:120-1.
2Fitzpatrick D, Gandras EJ, Greben CR, Restrepo G, Avi S. Embolization of an External Carotid Artery Mycotic Aneurysm. Endovascular Today 2009. p. 61-63.
3Mukherjee D, Roffi M, Yadav JS. Endovascular treatment of carotid artery aneurysm with stent grafts. J Invasive Cardiol 2002;14:269-72.
4Nadig S, Barnwell S, Wax MK. Pseudoaneurysm of the external carotid artery-review of literature. Head and Neck. Vol. 31. John Wiley and Sons Inc, Maiden MA, USA 2009. p. 136-9.
5Simionato F, Righi C, Melissano G, Rolli A, Chiesa R, Scotti G. Stent-graft treatment of a common carotid artery pseudoaneurysm. J Endovasc Ther 2000;7:136-40.
6Grigoryants V, Eagleton MJ, Upchurch GR Jr, Bilateral external carotid artery aneurysm. Vascular 2004;12:387-9.