The World of the Vascular Surgeon: Knowledge of Anatomical Landmarks for Successful Surgical Outcomes

Abstract

To prevent strokes in at‐risk patients, the vascular surgeon may choose from a variety of procedures to counter the accumulation of atheromatous plaque in the carotid arteries: open surgery in the neck with carotid endarterectomy (CEA), carotid stenting with less invasive endovascular techniques, and the more recently developed trans‐carotid artery revascularization (TCAR). The height of the carotid bifurcation (HCB) is an important landmark for the surgeon because it aids in determining the specific surgical approach used, while seeking to minimize the risk to cranial nerves and other vital structures. The HCB is classically defined in relation to the cervical vertebral levels, hyoid bone, thyroid cartilage, and the angle of the mandible. Substantial variability exists across population groups generating extensive research to identify the precise vertebral levels linked to HCB with respect to ethnic and gender differences with a focus on left/right asymmetries. Although well reported, the relationship between cervical vertebral levels and the HCB is of little use during operative procedures because the patient's cervical spine is not readily accessible in the surgical field. Thus, we attempt to elucidate the HCB using anatomical landmarks available while operating. Anatomical dissections were performed on the right and left sides of the neck in five cadavers and morphometric measures of surgical landmarks were obtained. The following ratios were calculated: medial border of the clavicle (MBC) to HCB/MBC to mastoid process (MP), MBC to superior thyroid artery (STA) origin/MBC to MP, and MBC to facial vein (FV) origin/MBC to MP. In addition to the first reported measurements of the HCB from these accessible landmarks, the study found there are statistical significant differences between the right and left sides of the neck among and between individuals. The MBC to bifurcation, MBC to STA origin, and the MBC to FV origin ratio was greater on the left side with 0.74 vs 0.64 (p= .008), 0.70 vs 0.64 (p= .02), and 0.69 vs 0.61 (p=.004), respectively. Our preliminary study addresses the lack of surgically relevant anatomical measures surrounding the carotid region and takes a step toward establishing useful anatomical ratios that may contribute to successful surgical outcomes.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.