A CASE OF GIANT ANEURYSM OF THE INTERNAL CAROTID ARTERY ASSOCIATED WITH MARFAN'S SYNDROME

Abstract

A 22-year-old man was referred to the department for the purpose of operation. Previous histories disclosed that he underwent resection of bulla 3 times at ages from 12 to 18 years; a tumor appeared on the right side of the neck at the age of 12 and became larger gradually; and the tumor was diagnosed as aneurysm of the right internal carotid artery on CT scan and angiography at the age of 20. On admission, the patient revealed tall stature, arachnodactyly, and characteristic physique of Marfan's syndrome and a pulsatile tumor 9.8cm in diameter in the right side of the neck was confirmed. Cervical CT scan showed a giant aneurysm on the right side of the neck and the lumen was filled with massive thrombi. Angiography revealed the huge aneurysm just above the beginning of right internal carotid artery as well as delayed fluoroscopy because of compressed internal cartid artery at the periphery side due to expansive growth of the aneurysm. With diagnoses of Marfan's syndrome and giant aneurysm of the internal carotid artery, an operation was performed by entertaining a possible risk of rupture. Operative procedures included that the autologous great saphenous vein was anastomosed to the end of right subclavian artery; the patient was kept under profound hypothermia of 18°C at the tympanic membrane; after cutting the beginning of the right internal carotid artery, periphery side of the right internal cartid artery was searched; and then an end-to-end anastomosis with the venous graft was conducted. The operation was completed with suture of the beginning of right internal cartid artery. The postoperative course was uneventful.