Elsevier

Annals of Vascular Surgery

Volume 29, Issue 2, February 2015, Pages 362.e1-362.e2
Annals of Vascular Surgery

Case Report
Subclavian Carotid Bypass of Occluded Common and Internal Carotid Arteries Facilitated by an Anomalous Branch of the Internal Carotid Artery

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Typically, internal carotid artery (ICA) occlusion precludes carotid endarterectomy. Extracranial branches of the ICA are uncommon. If this anomaly occurs in the setting of total proximal ICA occlusion then revascularization is feasible. We describe a unique example of such a case.

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Case Report

A 64-year-old man presented with a 4-month history of multiple episodes of near syncope and repetitive amaurosis fugax of the right eye. He was a heavy smoker despite having undergone chemotherapy and radiation for squamous cell carcinoma of the larynx 9 years earlier.

A carotid duplex ultrasound showed occlusion of the right common carotid artery (CCA) and ICA, but did not identify a reconstituted ICA. In addition, the left ICA had a 50–69% stenosis and there was rapid antegrade flow in the

Discussion

Anomalous branches of the ICA are relatively rare.2, 3 They were first described in the mid 19th century by Hryltle and Quain.1, 4, 5 Quain specifically mentions an occipital branch of the ICA.5 A recent study by Small et al. demonstrated a 0.49% prevalence of an anomalous occipital artery and a 6.25% prevalence of a superior pharyngeal artery from the ICA, both rates greater than previously seen in the literature.3 Although rare, anomalous branches of the ICA have significant implications in

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