ABSTRACT
Surgery for a relatively low bifurcation of the CCA may expose the omohyoid muscle. It is crucial to establish adequate control well below the carotid bulb in case placement of a shunt is necessary. I place the DeBakey cross-clamp at least 2 cm below the encircling vessel loop so that a shunt can be placed and the vessel loop snugged down around it before the cross-clamp is removed, thereby preventing significant bleeding. In order to do this, it is often necessary to identify and either retract or transect the omohyoid muscle. The muscle can be retracted from the overlying carotid artery with the vertically placed rostral-caudal retractor or it can be cauterized with the bipolar coagulator and cut to expose an adequate length of CCA. I like to tag the two ends of the muscle with suture ligatures and re-oppose them at the conclusion of the case. The CCA dives a little more deeply at the caudal end of the wound, and a significant surface dissection is necessary to expose it. In point of fact, exposure of an extremely low carotid bifurcation can be as difficult as exposure of a high bifurcation.
