title: Occlusion of the ascending pharyngeal artery during carotid artery surgery: importance and technique.
abstract: OBJECTIVE
  In surgeries involving clamping, opening and repairing the carotid artery such as carotid endarterectomy (CEA) and proximal anastomosis at radial artery (RA) grafting, back-bleeding, often due to insufficient occlusion of the ascending pharyngeal artery (APA), must be avoided. In 96% of cases the APA originates at the dorsal side of the external carotid artery, while in 2% each it arises at the carotid bifurcation or the internal carotid artery. We developed a method to prevent back-bleeding from the APA irrespective of its origin.
  
  
  METHODS
  For CEA we dissect the internal carotid artery and clamp the APA and the external carotid artery together. For RA grafting we dissect the external carotid artery and if the APA branches directly from this vessel, the APA is clamped directly.
  
  
  RESULTS
  We used our new surgical technique in 54 cases (22 CEA and 32 RA grafts) and encountered no major back-bleeding.
  
  
  CONCLUSIONS
  We consider this method to be simple and useful for improving the safety and success of carotid artery surgeries.
authors: Chiba-Hokusou Hospital, Nippon Medical School, Department of Neurosurgery, 1715 Kamagari, Inzai City, Chiba, Japan.
authors: Katsuya
authors: K
authors: Umeoka
authors: Takayuki
authors: T
authors: Mizunari
authors: Yasuo
authors: Y
authors: Murai
authors: Shiro
authors: S
authors: Kobayashi
authors: Akio
authors: A
authors: Morita
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000502:physiology*; D002339:Carotid Arteries / Q000601:surgery*; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010614:Pharynx / Q000098:blood supply*; D017534:Radial Artery / Q000637:transplantation; D012039:Regional Blood Flow / Q000502:physiology; D013525:Surgical Instruments; D014656:Vascular Surgical Procedures / Q000379:methods*