Axillo-internal carotid artery bypass in the treatment of neck metastases

The initial surgical management of neck metastases from head and neck cancer may be complicated if the tumor mass invades the carotid vessels. Acute carotid ligation is associated with a high stroke rate. Consequently preservation of flow to the internal carotid artery is desirable. We will describe two patients in whom preservation of flow was accomplished with the use of a saphenous vein bypass from the axillary artery to the internal carotid artery. The technique is described and has several advantages. First, it preserves flow to the internal carotid artery; second, it allows radical excision of tumor without compromising the margins of resection; and finally, at least one suture line and most of the graft are outside the field of radiation and remote from the wound closure. We believe that this technique is useful in the management of patients with disease that has metastasized to the neck.