Behcet extracranial carotid aneurysms: is there still a role for ligation?

Abstract

Aneurysm formation in Behcet's disease (BD) rarely involves extracranial carotid arteries. We report our experience of the management of extracranial carotid artery aneurysms (ECAAs) in BD. Data of patients with Behcet ECAAs presenting from 1997 to 2008 were retrospectively collected focusing on the different treatment modalities, the indications for each modality and the outcome. Twelve Behcet ECAAs were managed. Seven underwent ligation of the carotid artery, where the stump pressure exceeded 70 mmHg. The remaining five patients underwent vascular reconstruction: either excision and reconstruction by an autogenous vein interposition graft (n=3), excision and end-to-end anastomosis (n=1), or direct suture of a small rent in the artery (n=1). There were no perioperative mortalities or major strokes. There was one recurrent laryngeal nerve injury and one hematoma. There was one aneurysm recurrence, which was managed by ligation and resulted in a minor stroke. Surgical repair in Behcet ECAAs should be performed with special precautions in order to prevent anastomotic pseudoaneurysm formation. Ligation can be performed when the anatomical and/or pathological circumstances are not favourable, provided that the stump pressure is adequate to maintain cerebral perfusion.