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Ventromediale Lagevariante der A. carotis interna

Einfluss auf die Karotischirurgie?

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Zusammenfassung

Anatomie und Geometrie der Karotisgabel sind sehr komplex. Mediale und ventromediale Lagevariationen der ACI werden in der Literatur mit bis zu 6% angegeben. Damit sind sie nicht selten genug, um bei der Karotisdesobliteration nicht angetroffen zu werden. Ein Einfluss solcher Lagevariationen auf das chirurgische Vorgehen wurde bisher nicht beschrieben. Erst die Kombination mit höher gelegener Karotisgabel lässt ein technisches Problem entstehen.

3 Fälle (2 w., 1 m., Altersdurchschnitt 70 Jahre) mit medialer bzw. ventromedialer Lagevariante der ACI werden vorgestellt. Unter Schonung der A. carotis externa (ACE) war in 2 Fällen die „mediale“ Eversionsdesobliteration Maßnahme der Wahl, die problemlos vorgenommen werden konnte. Ein Fall mit medialer Lage der ACI konnte trotz erwarteter Schwierigkeiten konventionell desobliteriert werden.

Anatomie und Geometrie der Karotisgabel sind sehr variabel, doch beeinflussen sie im therapeutischen Falle in der Regel nicht das chirurgische Vorgehen. Die mediale und ventromediale Lage der ACI kann in seltenen Fällen eine modifizierte Technik erfordern.

Abstract

Anatomy and geometry of the carotid bifurcation are extremely complex. Medial and ventromedial positions of the internal carotid artery (ICA) account for approximately 6%. This is not rare enough that technical problems related to carotid TEA would not be encountered. However, medial and ventromedial positions of the ICA in combination with a high carotid bifurcation with implications for carotid endarterectomy are extremely rare.

Three cases (two women and one man, mean age: 70 years) with symptomatic ICA stenosis and medial or ventromedial position of the ICA underwent carotid thrombendarterectomy (TEA). In two patients conventional TEA without sacrificing the ECA was not feasible. A “medial” eversion TEA was performed. The third patient with medial position of the ICA and low position of the carotid bifurcation underwent conventional TEA with patch plasty.

In a few cases a medial and ventromedial position of the ICA may require a modified technical procedure. “Medial” carotid eversion TEA can easily be performed in these cases.

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Literatur

  1. Affeld K, Goubergrits L, Fernandez-Britto J, Falcon L (1998) Variability of the geometry of the human common carotid artery. A vessel cast study of 31 specimens. Path Res Pract 194/9: 597–602

    Google Scholar 

  2. Braeuer NR, Malamo JT, Lynch RD (1975) Anomalous lateral and inferior position of the external carotid artery: case report. J de l‚Association Canadienne des Radiologistes 26: 210–211

    Google Scholar 

  3. Faller A (1946) Zur Kenntnis der Gefäßverhältnisse der Karotisteilungsstelle. Schweiz Med Wochenschr 45: 1156–1158

    Google Scholar 

  4. Forster FK, Chikos PM, Frazier JS (1985) Geometric modeling of the carotid bifurcation in humans. Implications in ultrasonic Doppler and radiologic investigation. J Clin Ultrasound 13/6: 385–390

    Google Scholar 

  5. Giddens DP, Zarins CK, Glagov S (1993) The role of fluid mechanics in the localization and detection of atherosclerosis. J Biomech Engineering 115/4B: 588–594

  6. Glagov S, Zarins CK, Giddens DP, Ku DN (1988) Hemodynamics and Atherosclerosis—Insights and perspectives gained from studies of human arteries. Arch Pathol Lab Med 112/10: 1018–1031

    Google Scholar 

  7. Handa J, Matsuda M, Handa H (1972) Lateral position of the external carotid artery—Report of a case. Radiology 102/2: 361–362

    Google Scholar 

  8. Harrison MJG, Marshall J (1983) Does the geometry of the carotid bifurcation affect its predisposition to atheroma? Stroke 14: 117

    PubMed  Google Scholar 

  9. Hübner H-J (1967) Zum Verlauf der Arteria carotis interna im Bereich des Halses. Anat Anz 121/5: 489–496

    Google Scholar 

  10. Karino T, Goldsmith HL (1985) Particle flow behavior in models of branching vessels. II. Effects of branching angle and diameter ratio on flow patterns. Biorheology 22/2: 87–104

    Google Scholar 

  11. Karino T, Kwong HH, Goldsmith HL (1979) Particle flow behaviour in models of branching vessels: I. Vortices in 90 degrees T-junctions. Biorheology 16/3: 231–248

    Google Scholar 

  12. Kniemeyer HW, Aulich A, Schlachetzki F, Steinmetz H, Sandmann W (1996) Pseudo- and segmental occlusion of the internal carotid artery: New classification, surgical treatment and results. Eur J Vasc Endovasc Surg 12/3: 310–320

    Google Scholar 

  13. Perktold K, Rappitsch G (1995) Mathematical modeling of arterial blood flow and correlation to atherosclerosis. Technol Health Care 3/3: 139–151

    Google Scholar 

  14. Prendes JL, McKinney WM, Buonanno FS, Jones AM (1980) Anatomic variations of the carotid bifurcation affecting Doppler scan interpretation. J Clin Ultrasound 8/2: 147–150

    Google Scholar 

  15. Rindt CC, van Steenhoven AA, Reneman RS (1988) An experimental analysis of the flow field in a three dimensional model of the human carotid artery. J Biochem 23/11: 461–473

    Google Scholar 

  16. Sitzer M, Puac D, Buehler A et al. (2003) Internal carotid artery angle of origin: a novel risk factor for early carotid atherosclerosis. Stroke 34/4: 950–955

    Google Scholar 

  17. Smith D, Larsen JL (1979) On the symmetry and asymmetry of the bifurcation of the common carotid artery—A study of bilateral carotid angiograms in 100 adults. Neuroradiology 17: 245–247

    CAS  PubMed  Google Scholar 

  18. Sundt TM jr. (1993) Surgical and functional anatomy of the carotid triangle. In: Sundt TM (ed) Occlusive cerebrovascular disease

  19. Trigaux JP, Delchambre F, van Beers B (1990) Anatomical variations of the carotid bifurcation: implications for digital subtraction angiography and ultrasonography. Br J Radiol 63/747: 181–185

    Google Scholar 

  20. Ueda S, Kohyama Y, Takase K (1984) Peripheral hypoglossal nerve palsy caused by lateral position of the external carotid artery and an abnormal high position of bifurcation of the external and internal carotid arteries—A case report. Stroke 15/4: 736–739

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie und Phlebologie, Elisabeth Krankenhaus, Essen

    H. W. Kniemeyer, H. Beckmann, A. Soliman & A. Pühler

  2. Gefäßchirurgische Praxis, Hattingen/Ruhr

    M. Edelmann

  3. VASC, Zentrum für Angiologie und Gefäßchirurgie, Lindenhofspital , Bern, Schweiz

    P. Reber

  4. Klinik für Gefäßchirurgie und Phlebologie, Eliabeth-Krankenhaus Essen, Moltkestr. 61, 45138, Essen

    H. W. Kniemeyer

Authors
  1. H. W. Kniemeyer
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  2. M. Edelmann
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  3. P. Reber
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  4. H. Beckmann
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  5. A. Soliman
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  6. A. Pühler
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Correspondence to H. W. Kniemeyer.

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Kniemeyer, H.W., Edelmann, M., Reber, P. et al. Ventromediale Lagevariante der A. carotis interna. Gefässchirurgie 9, 19–24 (2004). https://doi.org/10.1007/s00772-003-0327-y

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  • DOI: https://doi.org/10.1007/s00772-003-0327-y

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