Carotid revascularization after cervical irradiation

Carotid revascularization after cervical irradiation is often made more difficult by decreased vascularity, development of fibrosis, and loss of covering tissue by previous surgery. We present three cases to illustrate alternative approaches to carotid revascularization in these circumstances. One case describes the usual direct approach to carotid endarterectomy. The second describes a saphenous vein bypass from the subclavian artery to the internal carotid artery, while the third describes a saphenous vein carotid-carotid bypass following carotid blowout. We discuss advantages of each approach and describe characteristics of the changes that follow cervical irradiation.