Anatomic evaluation of the carotid artery bifurcation in cadavers: implications for open and endovascular therapy

Abstract

Knowledge of carotid bifurcation (CB), common carotid artery (CCA) and its branches and their recognition during diagnostic imaging are also important for vascular surgical procedures in the region, such as carotid endarterectomy or radical neck dissection, catheterization and aneurysms. The surgical anatomy of the carotid arteries was studied in 20 cadavers. Micrometric values of the CB and its relation with surrounding structures, measurements belonging to the external carotid artery (ECA) and internal carotid artery (ICA), and metric data, such as lower face including the greater horn, laryngeal prominence have been evaluated by making linear measures. The diameter of the CCA at the CB under 2 cm and CB diameter was measured as 8.1 +/- 2.24 mm and 12.79 +/- 2.87 mm, respectively. Evaluating data related to the ICA and the ECA in samples, the aspect was measured the ICA and the ECA in the CB discrimination point as 21.52 +/- 20.53 degrees . In the most location of the ECA origin according to the ICA has been determined as medial position in 35 specimens. The origin of the superior thyroid artery (STA) was found to be at the same level with the CB in 40% and below it in 25% specimens. This study has provided measured objective criteria for the arterial features of the neck region, which are crucial during surgery. The origins of the branches of the CCA act as key landmarks for adequate and appropriate placement of the cross-clamp on the carotid arteries.

Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches

“…In the literature, this latter Wnding is usually found in close association with an anomalous origin of the STA from the CB or the CCA; in most of the cases to a CB at a normal level (superior border of the thyroid cartilage, C3-C4, 89% of the cases) [ANU] corresponds a normal origin from the ECA [20]. Following the Wnding of a high bifurcation, therefore, the surgeon and the interventional radiologist should suspect the possible origin of the STA from the CB or, less commonly, from the CCA [10,13,20,26].…”

Variations in the branching pattern of the External Carotid Artery

“…1 This also necessitates accurate interpretation of radiological images and proper planning of the surgical steps taken during the exploration of head and neck such as carotid endarterectomy, aneurysm repair, carotid angiogram and radical dissection of the lymph nodes. 2,3,4 The proper identification of the branches of the external carotid artery is imperative. 5,6 Branches of ECA are key landmarks for adequate dissection for exposure and appropriate placement of cross clamps on the carotid arteries or catheterization.…”

Angioplastia do bulbo carotídeo com colocação de stent: acompanhamento clínico e radiológico

“…Como a artéria carótida comum, artéria carótida externa e bifurcação carotídea são fontes de ramos arteriais que alimentam as regiões da cabeça e pescoço, as características anatômicas das artérias e vizinhança são conhecimentos importantes para a compreensão radiológica e acesso cirúrgico da região 22,23,24,25,26,27 .…”

“…Há relatos, ainda, de ausência completa das artérias carótidas comum e de artérias carótidas comum que não bifurcam 22,25,32 .…”

“…Um nível de bifurcação assimétrica entre os lados direito e esquerdo são frequentemente vistos, o lado esquerdo estando localizado cranialmente em 50% dos casos 22,32 . 47 .…”