ABSTRACT
A side-by-side carotid artery represents a more difficult anatomic dissection. In a case such as the one illustrated here, it is necessary to turn the head radically to the opposite side from the surgical incision, thereby swinging the ICA as far lateral as possible. Unfortunately, this process of head turning also brings the sternocleidomastoid muscle into such a position as to overlie the CCA and carotid bifurcation, and a much greater degree of retraction of both the sternocleidomastoid muscle and the jugular vein is necessary. I also often find it necessary to extensively mobilize the ECA in a side-byside carotid exposure and dissect much farther around the circumference of the artery than is customarily necessary. This is done to mobilize the ECA medially and allow it to be tacked up by its adventitia if necessary. All these maneuvers are designed to pull the ICA back out from its underlying position to the point where it pops out into a more standard anatomic exposure. (See Figs. 3-4 and 3-26.)
Exposure and mobilization of the ICA must be significantly higher than the extent of the plaque, usually up to the area of the artery’s lateral bend, as illustrated in the AP view by the arrow (so that the ICA essentially jumps out into a more normal position). Another strategy for accomplishing this is to tack the adventitia of the ICA laterally, once again holding it out in place for the arteriotomy.
