Triple variation in the vascular supply in the neck of a female donor body: a case report.

PURPOSE: Understanding the anatomical variations involving bifurcation of the common carotid artery, positioning of external and internal carotid arteries, and branching of the external carotid artery are of vital importance in neck surgeries such as carotid endarterectomies (CEA). METHODS: The neck of a 51-year-old female donor body was dissected to demonstrate the arterial network. RESULTS: Bifurcation of the common carotid artery occurred at the level of the C6-C7 intervertebral disc, significantly inferior to the generally accepted and taught anatomical location at the level of intervertebral disc between C3 and C4 vertebrae. When the arteries were followed superiorly after the bifurcation, a unique second variation was observed: translocation of the external and internal carotid arteries. The external carotid artery was located posterolaterally and the internal carotid artery was located more medially. Finally, a third variation was discovered in the form of a common thyrolingual trunk that gave rise to superior thyroid and lingual arteries rather than these arising independently from the external carotid artery. CONCLUSIONS: We report a unique triple variation within the major arteries of the neck that has not been previously reported in surveyed literature. This case report may provide useful information for cardiovascular surgeons performing CEA and for otolaryngologists performing prophylactic arterial ligation following transoral robotic surgery for oropharyngeal cancer resection.

Older age, carotid artery stenosis, and female sex as factors correlated with twisted carotid bifurcation based on 457 angiographic studies.

BACKGROUND: Twisted carotid bifurcation (TCB) is a well-known anatomical variation of the carotid bifurcation in patients undergoing carotid endarterectomy. However, few investigations of TCB have focused on patients without internal carotid artery (ICA) stenosis. This study was performed to analyze the characteristics of TCB in patients with ICA stenosis and other diverse pathologies. METHODS: All conventional cerebral angiographies performed in our institute for any reason from January 2012 to December 2018 were reviewed. The patients were divided into two groups, the TCB group and the anatomically normal non-TCB group, and the basic characteristics of the groups were analyzed. RESULTS: Both sides of the carotid bifurcation were clearly visualized in 457 patients. TCB was found in 89 of 457 patients (19.5%); among these 89 patients, 74 (83.1%) had TCB only on the right side, 8 (9.0%) only on the left side, and 7 (7.9%) bilaterally. TCB was found more frequently on the right than left [81 (17.7%) and 15 (3.3%), respectively, on each of the 457 sides (p < 0.0001)]. TCB was significantly more frequent in older patients (p = 0.02), female patients (p < 0.001), and patients with ICA stenosis or occlusion at the bifurcation (p = 0.005). The prevalence of TCB was 19.5%, and 84.4% of cases were on the right side in patients with diverse pathologies. CONCLUSIONS: Older patients, female patients, and patients with ICA stenosis or occlusion are more prone to have TCB.

Diagnosis and Operative Management of Carotid Endarterectomy in Patients with Twisted Carotid Bifurcation.

Although carotid endarterectomy (CEA) is an established procedure, technical modifications are required when anatomical features are unusual. The present study aimed to determine the characteristics of diagnostic features, surgical management, and outcomes of patients with a twisted carotid bifurcation (TCB). We assessed 108 consecutive patients by cervical carotid echography (CCE) and black-blood magnetic resonance imaging (BB-MRI) before they underwent 115 CEA procedures. We classified carotid bifurcation (CB) anatomy based on anteroposterior findings of the internal carotid artery (ICA) and external carotid artery (ECA) determined by cerebral or three-dimensional computed tomographic angiography as follows. The ICA and ECA ran laterally and medially, respectively, in Type 1, overlapped in Type 2, and the ICA and ECA ran medially and laterally, respectively, in Type 3. We also classified the patients according to whether or not they had a TCB and compared their diagnostic findings, clinical characteristics, and surgical outcomes. The numbers of patients with Types 1, 2, and 3 were 74 (64.4%), 32 (27.8%), and 9 (7.8%), respectively, and 13 (11.3%) with a TCB included four patients with Type 2 and all nine patients with Type 3. The appearance of Type 3 differed from that of the other two types on CCE and BB-MR images. After correcting the anatomical location of a TCB, surgical duration and adverse event rates did not significantly differ between patients with and without a TCB. Patients with a TCB could safely undergo CEA after correcting the ICA to the normal position.