Background: Spontaneous carotid artery aneurysms are infrequently reported,
and are almost always non-atherosclerotic.
Methods: The records of 29 patients with a spontaneous carotid aneurysm tre
ated in an academic vascular unit between 1990 and 1998 were reviewed.
Results: All 29 patients were black South Africans; three had bilateral ane
urysms. There were 24 men and five women, of mean age 35 (range 13-62) year
s. Some 25 aneurysms involved the common carotid artery, 12 of which affect
ed the bifurcation, and seven were located in the internal carotid artery.
Twenty-five aneurysms were managed surgically, four of which were ligated o
wing to sepsis. Histo- logical evaluation showed human immunodeficiency vir
us-related arteritis in four, tuberculous aneurysms in ten, Takayasu's arte
ritis in two, atherosclerosis in three and non-specific chronic inflammatio
n in four patients. Microbiological examination was negative in all but one
patient who had Salmonella sp. cultured. Outcome was generally favourable,
but one patient died from massive hemispheric infarction. There were no ot
her new neurological deficits.
Conclusion: Carotid aneurysms pose a considerable surgical challenge but ar
e amenable to operative intervention with good result. Ligation appears to
be well tolerated in this group of predominantly non-atherosclerotic aneury