Bilateral extracranial-intracranial bypass before carotid ligation for hemorrhage into a pharyngocutaneous fistula.

In this article we present a discussion of the surgical treatment of a patient with spontaneous hemorrhage of the right carotid artery at the site of a pharyngocutaneous fistula following radiation therapy and radical neck surgery for carcinoma of the tonsil. The patient had an atherosclerotic left common carotid artery occlusion. This is the first reported case of bilateral saphenous vein extracranial-intracranial arterial bypass (EIAB). The rationale and results of the operative procedures performed and the benefits of immediate high-flow bypass graft implanted outside the contaminated surgical field before carotid artery ligation are discussed. EIAB should be considered for patients requiring therapeutic carotid artery ligation who have potentially inadequate collateral cerebral blood flow due to associated extracranial or intracranial vascular occlusions or anomalies.