Resection and reconstruction of the carotid artery in metastatic squamous cell carcinoma

Although it is uncommon to consider resection of the common and internal carotid arteries for involvement by carcinoma, nevertheless, if this is the only significant finding precluding an adequate ablative procedure, this operation is worthy of consideration. Ten procedures were performed in nine such patients; the carotid bifurcation was resected and continuity reestablished using Teflon or autogenous saphenous vein grafts. In attempting to predict the efficiency of the collateral cerebral cross-flow, arteriography, oculopneumoplethysmography and intraoperative measurement of carotid stump pressure were used in some patients. There was no operative mortality. The postoperative mortality rate was 20 percent and cerebrovascular complications occurred in 20 percent of the cases. Seven patients survived 19 months to 4 1/4 years. Teflon grafts appeared to have a higher patency rate than saphenous vein autogenous grafts. Although this series is very small, it is an evaluation of a procedure of last resort which appears worthwhile in carefully selected patients.