Leonard Samuel D, Sadri Lili, Nguyen Hung, Saqib Naveed, Heck Marvin, Martin Gordon
Department of Surgery and Perioperative Care, University of Texas at Austin, Dell Medical School, Austin, TX.
Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX.
J Vasc Surg Cases Innov Tech. 2024 Oct 22;11(1):101648. doi: 10.1016/j.jvscit.2024.101648. eCollection 2025 Feb.
Persistent hypoglossal artery (PHA) is a rare, anatomical variant in which the posterior cerebral circulation is primarily supplied by a branch of the carotid artery, rather than the vertebral arteries. This case report discusses carotid endarterectomy performed on a man, 67 years of age, with high-grade, asymptomatic carotid artery stenosis and ipsilateral PHA. Preoperative computed tomography angiography identified the PHA arising from the internal carotid artery, compensating for atretic bilateral vertebral arteries and providing primary perfusion to anterior spinal artery. A carotid endarterectomy with a bovine pericardial patch was executed under general anesthesia, incorporating preemptive shunting of the PHA and intraoperative electroencephalogram monitoring. The operation proceeded without complications, maintaining normal electroencephalogram readings, and the patient exhibited no focal neurological deficits postoperatively, although transient dysphagia was noted. Follow-up imaging at 4 months confirmed the patency of the internal carotid artery and PHA. This case underscores the necessity for meticulous surgical planning and monitoring in the presence of rare vascular anomalies to ensure successful outcomes. The key takeaway is that comprehensive, preoperative imaging, individualized surgical strategies, and vigilant postoperative monitoring are critical for managing rare vascular anomalies, such as PHA.
永存舌下动脉（PHA）是一种罕见的解剖变异，其中大脑后循环主要由颈动脉的一个分支供血，而非椎动脉。本病例报告讨论了对一名67岁男性进行的颈动脉内膜切除术，该患者患有高级别无症状颈动脉狭窄及同侧PHA。术前计算机断层血管造影显示PHA起源于颈内动脉，代偿双侧闭锁的椎动脉并为脊髓前动脉提供主要灌注。在全身麻醉下进行了带牛心包补片的颈动脉内膜切除术，术中对PHA进行了预防性分流并进行了脑电图监测。手术过程顺利，脑电图读数正常，患者术后虽出现短暂吞咽困难，但无局灶性神经功能缺损。4个月后的随访影像学检查证实颈内动脉和PHA通畅。该病例强调了在存在罕见血管异常的情况下进行细致手术规划和监测以确保成功结果的必要性。关键要点是，全面的术前影像学检查、个体化的手术策略以及术后的密切监测对于处理罕见血管异常（如PHA）至关重要。
