Turkish Neurosurgery 2014 , Vol 24 , Num 4
Occlusion of the Ascending Pharyngeal Artery During Carotid Artery Surgery: Importance and Technique
Katsuya UMEOKA1, Takayuki MIZUNARI1, Yasuo MURAI2, Shiro KOBAYASHI1, Akio MORITA2
1Chiba-Hokusou Hospital, Nippon Medical School, Department of Neurosurgery, 1715 Kamagari, Inzai City, Chiba, Japan
2Nippon Medical School, Department of Neurosurgery, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
DOI : 10.5137/1019-5149.JTN.9527-13.0 AIM: In surgeries involving clamping, opening and repairing the carotid artery such as carotid endarterectomy (CEA) and proximal anastomosis at radial artery (RA) grafting, back-bleeding, often due to insufficient occlusion of the ascending pharyngeal artery (APA), must be avoided. In 96% of cases the APA originates at the dorsal side of the external carotid artery, while in 2% each it arises at the carotid bifurcation or the internal carotid artery. We developed a method to prevent back-bleeding from the APA irrespective of its origin.

MATERIAL and METHODS: For CEA we dissect the internal carotid artery and clamp the APA and the external carotid artery together. For RA grafting we dissect the external carotid artery and if the APA branches directly from this vessel, the APA is clamped directly.

RESULTS: We used our new surgical technique in 54 cases (22 CEA and 32 RA grafts) and encountered no major back-bleeding.

CONCLUSION: We consider this method to be simple and useful for improving the safety and success of carotid artery surgeries. Keywords : Carotid endarterectomy, Radial artery grafting, Ascending pharyngeal artery, Back-bleeding

Corresponding author : Katsuya Umeoka, katsuya@nms.ac.jp