Related Experiment Video
Updated: Mar 12, 2026
Training a Sophisticated Microsurgical Technique: Interposition of External Jugular Vein Graft in the Common Carotid Artery in Rats
Published on: November 11, 2012
[Comparison of antejugular and retrojugular approaches to the carotid bifurcation: a prospective randomized study]
A V Maksimov1,2,3, R M Mullakhmetov1, R M Nuretdinov1
1Republican Clinical Hospital, Ministry of Health of the Republic of Tatarstan, 420138, Kazan, Russian Federation.
Insights
The retrojugular approach to carotid endarterectomy offers no significant advantage over the antejugular approach in preventing neurological complications or reducing operative time. Both methods show similar safety profiles for stroke prevention surgery.
Area of Science:
- Vascular Surgery
- Neurology
- Surgical Techniques
Background:
- Carotid endarterectomy is a primary stroke prevention procedure.
- Standardization of carotid bifurcation dissection techniques remains a challenge.
- Existing data suggest potential differences in safety and efficacy between antejugular and retrojugular approaches.
Purpose of the Study:
- To prospectively compare the safety and efficacy of antejugular versus retrojugular approaches for carotid bifurcation dissection.
- To evaluate complication rates, including local neurological deficits and wound complications.
Main Methods:
- A prospective randomized study involving 280 patients with internal carotid artery stenosis.
- Patients were randomized into either the retrojugular (n=140) or antejugular (n=140) approach groups.
- Key outcomes included perioperative stroke, transient ischemic attacks, hematomas, and cranial nerve injuries.
Main Results:
- No significant differences were observed in the incidence of perioperative cerebral circulatory disorders, transient ischemic attacks, or hematomas between the two approaches.
- Local neurological symptoms, such as dysphonia and vocal fold paresis, showed comparable frequencies and complete regression in all patients within three months.
- Operative duration was similar for both the antejugular (76.1 min) and retrojugular (74.2 min) approaches.
Conclusions:
- The retrojugular approach, while facilitating carotid artery exposure, does not offer superior outcomes regarding local neurological complications or operative time compared to the antejugular approach.
- Both surgical techniques demonstrate comparable safety profiles for carotid endarterectomy.
- The choice between antejugular and retrojugular approaches should be based on surgeon preference and individual patient anatomy.
Abstract:
Carotid endarterectomy is the gold standard for stroke prevention. Although it is one of the most common procedures in vascular surgery, its technique has not been fully standardized. In particular, there is no consensus on the optimal approach for dissection of the carotid bifurcation. Data suggest differences in the safety and efficacy of the retrojugular and/or antejugular approaches, primarily regarding local wound complications and the incidence of cranial nerve injuries, which occur in 1.4-31% of cases and significantly impair patients' quality of life.
Objective:
To compare the safety and efficacy of the antejugular and retrojugular approaches to the carotid bifurcation within a prospective randomized study.
Material And Methods:
The study enrolled 280 patients (140 retrojugular, 140 antejugular).
Inclusion Criteria:
internal carotid artery (ICA) stenosis >70% (asymptomatic) or >50% (symptomatic).
Exclusion Criteria:
primary - pre-existing neurological deficits, reoperations. secondary - perioperative stroke, wound hematomas, early reinterventions.
Design:
Prospective randomized study.
Results:
Common complications: perioperative acute cerebral circulatory disorders/transient ischemic attacks - 2.14%/1.43% with antejugular access, 1.43%/0.71% with retrojugular access (p=0.658/0.566); hematomas - 0.7%/2.1%, respectively (p=0.63). Local neurological symptoms: on day 1 - 33.8% (dysphonia - 33.1%, vocal fold paresis - 1.9%), on day 3 - 22.9%, after 3 months - complete regression in all patients. After applying the secondary exclusion criteria, 134 patients with retrojugular access and 132 patients with antejugular access were included in the comparative analysis. The frequency of cranial nerve damage, dysphonia, and dysphagia did not differ depending on the type of access (p>0.05). The surgery time was 76.1±1.8 min (antejugular) vs 74.2±2.4 min (retrojugular, p=0.51).
Conclusion:
The retrojugular approach facilitates internal carotid artery exposure and obviates venous ligation but does not reduce local neurological complications or operative duration compared to the antejugular approach. Both techniques demonstrate comparable safety profiles, with approach selection contingent on surgeon preference and patient-specific anatomy.
Related Concept Videos
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:23Assessment of blood pressure in brachial artery(two-step method)
01:12Arteries of the Upper Limbs
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:19Veins of Head and Neck
On the other hand, the vertebral veins, unlike their arterial counterparts, are not primarily responsible for brain drainage. Instead, they drain the cervical vertebrae, spinal cord, and some small...