Successful Surgical Repair of Extracranial Internal Carotid Artery Aneurysm in A Patient with Behcet's Disease: A Case Report

Introduction and importance: Behçet's disease (BP) is a chronic, recurrent inflammatory multi-systemic vasculitis of unknown aetiology that initially presented with a triad of recurrent oral ulcers, genital ulcers, and uveitis. Vascular involvement, especially arterial involvement, is one of the significant causes of morbidity and mortality. Case presentation: A 25-year-old man presented with a sore throat, dysphagia, weight loss (8 kg in 2 months), and swelling on the left side of his neck. He was referred to our vascular surgery department for assessment of an expanding pulsatile mass in the left side of his neck, which was associated with numbness and weakness in the right side of his body. Neck CTA revealed a 43 x 42.3 x 35.8 mm pseudoaneurysm in the left internal carotid artery. The pseudoaneurysm was excluded. Reconstruction was performed with a bypass from the CCA to the ICA using a reversed great saphenous vein graft interposition. Clinical discussion: Extracranial carotid artery aneurysms (ECAAs) are rare and distinct from the more common atherosclerotic occlusive disease in the same location. This rarity underscores the unique and complex nature of the case. The primary objective of treating ECAAs is to prevent permanent neurologic deficits that may arise from atheroembolism and thromboembolism. The main goal is achieved by excluding the aneurysm from the arterial circulation and restoring antegrade flow. Conclusion: It is crucial to note that extracranial carotid artery aneurysms (ECAAs) and pseudoaneurysms, while rare, can have significant consequences. Their asymptomatic nature and the variability of their symptoms according to location, size, and aetiology underscore the urgency and seriousness of prompt treatment.