NECK DISSECTION WITH SIMULTANEOUS CAROTID ENDARTERECTOMY

Background: Patients with metastatic neck disease from upper aerodiges tive tract carcinomas have an extensive history of tobacco and alcohol abuse, These patients are predisposed to develop atherosclerotic vasc ular disease. Objective: An increased incidence and severity of caroti d stenosis in patients receiving radiotherapy for head and neck cancer s is known. Management of patients with severe carotid stenosis who re quire surgical treatment of their neck disease has not been described . The authors describe our experience with simultaneous carotid endart erectomy and neck dissection. Study Design: Prospective data collectio n. Methods: From 1991 to 1997 at West Virginia University Hospitals, M organtown, West Virginia, and State University of New York (SUNY) at B uffalo, three patients with severe carotid stenosis required surgery f or metastatic neck disease. Preoperative evaluation revealed a bilater al carotid stenosis greater than 90% in all patients. All patients und erwent modified radical neck dissections and simultaneous carotid enda rterectomies with saphenous vein grafting. Two patients, one undergoin g partial pharyngectomy and laryngectomy and the other a laryngectomy and neck dissection, had coverage of the carotid artery with the myoge nous component of a pectoral major graft, One patient had only a neck dissection. Results: Two patients healed with no local morbidity, no n eck recurrence, and a patent carotid artery by Doppler, No strokes wer e encountered. One patient died of a myocardial infarction, Conclusion : Severe carotid stenosis that requires revascularization may have end arterectomy performed simultaneously with treatment of head and neck p rimary with no increase in morbidity.