Transcervical Open Repair of Extracranial Internal Carotid Artery Aneurysm

1. Introduction

2. Prep and Drape

1. Preparing the Field
2. Applying the First Layer of Drapes
3. Fixing the First Layer of Drapes to the Skin
4. Applying the Second Layer of Drapes
5. Setting up Electrocautery and Suction

3. Incision and Exposure

1. Incision
2. Extending the Incision into Subcutaneous Tissue and Platysma
3. Increasing Exposure
4. Dissection Through the Investing Layer of Cervical Fascia Across the Medial Border of Sternocleidomastoid Muscle
5. Accessing the Vascular Sheath
6. Identification and Ligation of the Small Sternomastoid Branch of the Superior Thyroid Artery
7. Dissection of Carotid Sheath Vessels
8. Isolating Internal Carotid Artery with an Elastic Vascular Loop away from Bifurcation
9. Identification, Ligation, and Separation of the Anterior Attachment of the Posterior Belly of Digastric Muscle and the Common Facial Vein
10. Excising the Posterior Belly of Digastric Muscle
11. Technique for Controlling Hemorrhage from Accidental Vessel Injury
12. Further Dissection to Expose Aneurysm
13. More Technique for Controlling Hemorrhage from Accidental Vessel Injury
14. Finish Dissection to Expose the Entire Aneurysm

4. Excision of Aneurysmal Sac

1. Division of External Carotid Artery
2. Division of the Internal Carotid Artery and Accessing the Lumen of the Aneurysm
3. Excision of Aneurysm Wall and Debridement

5. Carotid Arterioplasty

1. Primary Repair of Common Carotid Artery Wall
2. Primary End-to-End Anastomosis of Internal Carotid Artery
3. Catheterization of Internal Jugular Vein and Insertion of Tissue Drain

6. Closure

7. Post-op Remarks