Carotid resection and replacement with autogenous arterial graft during operation for neck malignancy

Carotid artery resection as part of the management of advanced head and neck cancers remains controversial. Since 1991, 30 patients have undergone resection of the carotid artery with immediate reconstruction using superficial femoral artery as replacement conduit. There was one stroke/death. Forty-three percent developed neck wound problems but no grafts failed or hemorrhaged. Mean follow-up was 20 months (3-76) and mean life expectancy was 16 months from the time of surgery. Fifty-eight percent were free of local recurrence at the time of death. There was a 35% disease-free survival rate at 2 years. These results compare favorably with alternative therapy including carotid ligation or shaving tumor from the carotid artery. Given the importance of cerebral perfusion and local tumor control we offer superficial femoral artery as a durable conduit for immediate extracranial carotid reconstruction in the often hostile environment associated with cancer resection in the neck.