Occlusion of the common carotid artery (CCA) has been reported to occur in as high as 3 to 20% of patients with symptomatic extracranial cerebrovascular disease, although a more recent report estimates this to be 2%.2 Successful extracranial cerebrovascular revascularization can be accomplished only if a patent internal carotid artery or external carotid artery is present.In patients with CCA occlusion, conventional angiographic techniques have been able to predict internal or external carotid artery patency in only 26% of patients found to have either patent at the time of surgical exploration.2 Therefore, exploration of the carotid bifurcation has been recommended in symptomatic patients despite angiographic nonvisualization of its branches.2,3 Other modalities are needed to document internal and/ or external carotid artery patency in patients with common carotid artery occlusion. Although
During infragenicular bypass, internal occlusion of the distal vessel avoids unnecessary dissection and potentially damaging use of external clamps or vessel loops while improving exposure and patency. This technique is especially useful in patients with small or calcific vessels in whom distal reconstruction is necessary for limb salvage.
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