Anatomy - Left carotid bifurcation eversion endarterectomy (EEA) in symptomatic carotid bifurcation stenosis – Vascular Surgery

  1. Common carotid artery

    Common carotid artery
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    Origin

    • Left: aortic arch
    • Right: brachiocephalic trunk

    Course

    • Ascends posteriad to the sternocleidomastoid muscle
    • Within the carotid sheath

    Division

    • Carotid bifurcation: divides into internal and external carotid artery

    Distribution

    1. Internal carotid artery

    • Brain
    • Eye
    • Forehead
    • Anterior nasal cavity

    2. External carotid artery

    • Extracranial structures of the head and neck
  2. Internal carotid artery

    Origin

    • Branch of the common carotid artery (carotid bifurcation)

    Caudocephalad course

    1. Cervical part

    • Segment between origin of common carotid artery and base of skull
    • Enters the skull via the carotid canal
    • Does not give rise to any branches

    2. Petrous part

    • Courses in the petrous portion of the temporal bone
    • Minor branches to the tympanic cavity and pterygoid canal

    3. Cerebral part

    • Courses in the subarachnoid space
    • Passes through the dura mater
    • Divides into anterior and middle cerebral artery
    • Anterior cerebral artery communicates via the anterior communicating artery with the contralateral anterior cerebral artery

    The arterial vascular ring at the base of the brain supplying it with blood is known as the cerebral arterial circle (of Willis). From anterior to posterior, it comprises the following vessels:

    • Anterior communicating artery (unpaired)
    • Anterior cerebral artery (left and right)
    • Internal carotid artery (left and right) and its direct continuation, the middle cerebral artery
    • Posterior communicating artery (left and right)
    • Posterior cerebral artery (left and right, both arising from the basilar artery).

    However, the circle of Willis has numerous variations both in branch caliber and anastomoses (hypoplasia of individual branches or even agenesis of subsegments). This is clinically relevant for collateral blood supply in stenosis.

  3. External carotid artery

    The areas supplied by the external carotid artery can be divided into four groups depending on their location: anterior, middle and posterior group and the terminal branches.

    1. Anterior group

    Branches (cranial -→ caudal)

    Branches

    Area supplied

    Thyroid artery

    • Infrahyoid branch
    • Cricothyreoid branch
    • Sternocleidomastoid branch
    • Homonymous muscles
    • Superior laryngeal artery
    • Inner larynx
    • Glandular branches
    • Thyroid gland

    Lingual artery

    • Suprahyoid branch
    • Hyoid bone
    • Dorsal lingual branches
    • Dorsum of tongue
    • Sublingual artery
    • Sublingual gland
    • Deep lingual artery
    • Tip of tongue

    Facial artery

    • Ascending palatine artery
    • Soft palate
    • Tonsils
    • Pharynx
    • Submental artery
    • Submandibular gland
    • Suprahyoid muscles
    • Inferior labial artery
    • Lower lip
    • Superior labial artery
    • Upper lip
    • Angular artery
    • Medial canthus
    2. Middle group

    Branches (cranial -→ caudal)

    Branches

    Area supplied

    Ascending pharyngeal artery

    • Pharyngeal branches
    • Pharynx
    • Inferior tympanic artery
    • Tympanic cavity
    • Posterior meningeal artery
    • Dura mater
    3. Posterior group

    Branches (cranial -→ caudal)

    Branches

    Area supplied

    Occipital artery

    • Mastoid branch
    • Mastoid cells
    • Occipital branches
    • Occipital region
    • Meningeal branch
    • Dura mater

    Posterior auricular artery

    • Auricular branch
    • External ear
    • Occipital branch
    • Occipital region
    • Stylomastoid artery
    • Facial nerve
    • Tympanic cavity
    • Mastoid cells
    • Posterior tympanic arteries
    • Tympanic cavity
    • Mastoid cells
    • Pharyngeal branches
    • Pharynx
    • Parotid branch
    • Parotid gland
    • Parotid branch
    • Parotid gland

     

    4. Terminal branches

    Branches (cranial -→ caudal)

    Area supplied

    Superficial temporal artery

    • Transverse facial artery
    • Face
    • Zygomatico-orbital artery
    • Lateral canthus
    • Middle temporal artery
    • Temporalis muscle
    • Frontal branch
    • Scalp

    Maxillary artery

    Mandibular part

    • Deep auricular artery
    • Temporomandibular joint
    • External acoustic meatus
    • Anterior tympanic artery
    • Tympanic cavity
    • Inferior alveolar artery
    • Teeth
    • Mandibula
    • Mylohyoid branch: floor of mouth
    • Mental branch: chin
    • Middle meningeal artery
    • Meninges

    Pterygoid part

    • Masseteric artery
    • Masseter muscle
    • Pterygoid branches
    • Pterygoid muscles
    • Deep temporal arteries
    • Temporalis muscle
    • Buccal artery
    • Buccinator muscle

    Pterygopalatine part

    • Posterior superior alveolar artery
    • Teeth
    • Maxilla
    • Infraorbital artery
    • Maxilla
    • Descending palatine artery
    • Tonsils
    • Soft palate
    • Sphenopalatine artery
    • Nasal cavity
    • Nasal septum
    • Artery of pterygoid canal
    • Pharynx
    • Tympanic cavity
Venous systems

The superficial and deep venous systems join in the venous (Pirogoff) angulus to become the brachio

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