Risks associated with carotid artery aneurysms are treated most successfully by which of the following?

C. Resection and graft replacement.

D. Resection and reanastomosis.

DISCUSSION: Proximal ligation was the first method of surgical treatment and was employed during the nineteenth and early twentieth centuries, but a high incidence of stroke was associated with its use. Gradual occlusion over several days with a Crutchfield clamp can be used in the rare instance when resection and restoration of flow cannot be performed. Reports from the first part of this century indicate that observation of symptomatic carotid aneurysms yielded a high incidence of stroke and subsequent death. The preferred management of carotid aneurysms is resection and either reanastomosis of the internal and common carotid arteries or interposition graft replacement. Large aneurysms frequently require interposition grafting. Most aneurysms can be removed successfully, and flow can be re-established by reanastomosis. Currently, this is being achieved with a combined operative stroke and mortality rate of less than 2%.