Selection of the approach to the distal internal carotid artery from the second cervical vertebra to the base of the skull Charles N. Mock, MD, Michael.

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Presentation transcript:

Selection of the approach to the distal internal carotid artery from the second cervical vertebra to the base of the skull Charles N. Mock, MD, Michael P. Lilly, MD, Robert G. McRae, MD, Wilfred I. Carney, MD Journal of Vascular Surgery Volume 13, Issue 6, Pages 846-853 (June 1991) DOI: 10.1016/0741-5214(91)90050-5 Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Selective left carotid arteriogram of patient 1. A 75% stenosis of the left ICA is evident at the level of the space between the first and second cervical vertibrae. Journal of Vascular Surgery 1991 13, 846-853DOI: (10.1016/0741-5214(91)90050-5) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Selective left carotid arteriogram of patient 3. A 1 cm pseudoaneurysm of the distal cervical ICA can be seen cephalad to the first cervical vertebra. Journal of Vascular Surgery 1991 13, 846-853DOI: (10.1016/0741-5214(91)90050-5) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Lateral cervical radiograph of a representative anatomic specimen. The metal clips were placed on the ICA at the distal extent of exposure obtained with each of the surgical techniques studied. From caudal to cephalad, the clips represent the distal exposure provided by (1) standard approach, (2) standard approach with division of the digastric muscle, (3) standard approach with division of the digastric muscle and mandibular subluxation, (4) standard approach with division of the digastric muscle and mandibular subluxation and styloidectomy, and (5) all of the above plus lateral mandibulotomy. B, Schematic diagram of the radiograph in A. Journal of Vascular Surgery 1991 13, 846-853DOI: (10.1016/0741-5214(91)90050-5) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Frequency histogram of the distribution of the distal extent of cervical internal carotid dissection by each of the surgical techniques studied in 24 carotid specimens. Digastrx, Division of the posterior belly of the digastric muscle; Mand Sublx, division of the posterior belly of the digastric muscle with mandibular subluxation; Mand sublx + stylx, division of the posterior belly of the digastric muscle with mandibular subluxation and division of the styloid process. Each of these distributions is different from the others (p < 0.05, MWU). Journal of Vascular Surgery 1991 13, 846-853DOI: (10.1016/0741-5214(91)90050-5) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions