One stage ipsilateral vascular reconstruction of the carotid artery--distal or proximal limits at cervical operation

Since 1990, in treating 10 cases with head and neck tumors which had invaded the carotid artery, the authors have performed vascular reconstruction of the carotid artery. The standard surgical procedure is en bloc resection of the tumor and carotid artery and one stage ipsilateral vascular reconstruction of the carotid artery at cervical operation using a temporary shunt tube. When the tumor is located in a distal or proximal cervical portion, craniotomy or thoracotomy is needed in addition to the usual surgical procedure. The author classifies one stage ipsilateral reconstruction of the carotid artery into four types, depending on the anastomotic site, and describes distal or proximal limits of this procedure at cervical operation. Type A: Cervical operation after partial resection of the carotid wall; Patch angioplasty or simple arteriorrhaphy. Type B: Cervical operation after round resection of the carotid wall; Common carotid-internal carotid artery graft interposition, etc. Type C: Using craniotomy in addition to the cervical operation; Common carotid-middle cerebral artery bypass, etc. Type D: Using thoracotomy in addition to the cervical operation; Transthoracic subclavian-internal carotid artery bypass, etc. The design of the operative technique and adjunct enable distal or proximal limits of this procedure to be expanded. It is necessary to discuss the limits of this procedure in each case. Selecting an adequate surgical procedure based on intraoperative findings requires close teamwork with neurosurgeons and thoracic surgeons.