ABSTRACT
An ascending pharyngeal artery occasionally arises from the carotid bifurcation rather than from the sidewall of the ECA, and will need to be isolated with a separate 2-0 silk Pott’s tie or a bulldog clamp. This figure illustrates one such case. Because this artery was large and was identified on the preoperative arteriograms, I was alerted in advance. The inability to recognize arteries of this type leads to significant back-bleeding when the vessel is opened, obscuring the surgical field and rendering the meticulous dissection necessary for shunt placement and successful endarterectomy more difficult. It is essential to study the arteriogram to identify extra vessels and prevent this sort of complication.
