ABSTRACT
This lateral radiograph of a left carotid artery demonstrates a high bifurcation. In addition, an important anatomic anomaly is apparent, and this type of variation must be recognized before surgery. The ascending pharyngeal artery originates from the carotid bifurcation, as indicated on the photograph. If this condition is not recognized preoperatively and the vessel is not controlled in the same fashion as the superior thyroid artery, troublesome backbleeding will be the result and will render the arterial repair extremely difficult. At surgery, a vessel like this is often found to be densely adherent to either the internal or external carotid artery and it may not be immediately apparent that it is a separate vessel. However, when it is angiographically identified as it has been here, a careful search must be conducted until the vessel is identified and isolated to provide adequate hemostasis. A similar case is illustrated in an intraoperative photograph in Figs. 3-29 and 3-30.
