ABSTRACT
In this left CEA, the jugular vein is retracted and the carotid sheath is opened after administration of heparin to give the first exposure of the CCA. Before dissecting up into the carotid bulb and the internal and external carotid arteries, I ascertain that an adequate segment of CCA has been isolated and prepared for cross-clamping. I then establish control by passing a vessel loop around it with a right-angled mosquito clamp, and I secure this with a Rummel tourniquet, which is necessary in the event a shunt must be placed. Gaining control of the CCA at this stage ensures that any inadvertent misadventure into the carotid branches during further dissection can be quickly controlled by securing the CCA with a cross-clamp. Fortunately, however, this complication is rare. Dissection then proceeds up into the region of the carotid bulb and then up both the external and internal carotid arteries by separate incisions along the carotid sheath.
