Rutherford's 097: Carotid Artery Aneurysms скачать в хорошем качестве

Rutherford's 097: Carotid Artery Aneurysms

#ExtracranialCarotidArteryAneurysm #ECAA #CarotidAneurysm #VascularSurgery #EndovascularTherapy #StrokePrevention #NeckMass #Rutherfords This video delves into Extracranial Carotid Artery Aneurysms (ECAAs), rare bulges in the carotid arteries outside the skull. Unlike common carotid stenosis (narrowing), these aneurysms involve the artery swelling significantly, typically 50% larger than normal. Historically, infection was a major cause, leading to "mycotic" aneurysms, but now atherosclerosis, trauma, post-surgical complications (like after carotid endarterectomy), connective tissue disorders, and fibromuscular dysplasia are more common drivers, often affecting different age groups. ECAAs are uncommon, making up only 1-2% of carotid procedures, though improved imaging like ultrasound, CTA, and MRA has increased detection. Symptoms vary but often include a painless, pulsating neck mass. High aneurysms may present as a mass in the throat. Neurological events like TIAs or strokes, caused by clots breaking off (embolism), are a significant concern. Cranial nerve compression can lead to symptoms like Horner syndrome, hoarseness, or facial pain. Rupture is rare but serious. Diagnosis primarily uses non-invasive imaging (ultrasound, CTA, MRA), with catheter angiography sometimes used for treatment planning. The decision to treat is complex, considering size, growth, symptoms, cause, and patient health. While historical approaches were aggressive due to perceived high risk, current thinking allows for careful observation of small, asymptomatic aneurysms, especially in older, high-risk patients. Treatment aims to exclude the aneurysm and restore normal flow. Options include traditional open surgery (resection and reconstruction with grafts, often using vein) and less invasive endovascular techniques (stents, covered stent grafts, coiling). Open surgery risks cranial nerve injury, while endovascular methods often have lower nerve injury risk, particularly for high aneurysms. TCAR (Transcarotid Artery Revascularization) using flow reversal is a newer endovascular approach. Outcomes have significantly improved compared to historical ligation, with modern open surgery and endovascular approaches showing relatively low stroke/death risks, though complications like nerve injury (open surgery) or restenosis can occur. Managing infected aneurysms involves aggressive antibiotic therapy. Children with ECAAs present unique challenges and risks. Treatment is highly tailored to the specific aneurysm and patient. This information is informed by authoritative sources like Rutherford's Vascular Surgery textbook.