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Expanding Inflow Options: Common Carotid Artery for Limb Salvage
Joshua E Riklan, Martin Back
University of Florida, Gainesville, FL
BACKGROUND: The purpose of this study is to describe a novel technique for lower extremity bypass using the common carotid artery as a source for inflow. We aim to detail our institution's experience with this procedure and assess early clinical outcomes. To our knowledge, this technique has not been previously described.
METHODS: CPT codes 35621 and 35654 were used to query an internal patient database of patients who had undergone an axillary-femoral artery bypass or axillary-bifemoral artery bypass with material other than vein between 1/1/2010 and 10/1/2024. Chart review was performed to select those patients who had undergone a lower extremity revascularization procedure using the common carotid artery. Of the 421 cases identified, 6 patients had received a lower extremity revascularization procedure using the common carotid as the inflow source. The study was approved by our institution's IRB.
RESULTS: Six patients underwent revascularization using the common carotid artery as inflow to a lower extremity target; 67% were female, with a mean age of 70.2 years (SD 9.86). A transverse incision was made over the common carotid artery superior to the clavicle in the neck, followed by creation of a subcutaneous tunnel over the clavicle to a counterincision; the location of the counterincision and the lower extremity incision was patient-specific, determined by the sites of infection and the need to tunnel through noninfected tissue planes. All presented with graft infections and no other revascularization options. Postoperatively, all grafts were patent, with no strokes were observed. One patient had an NSTEMI, but no other cardiac events occurred. At 1 month, all grafts remained patent in patients with follow-up data, and no major adverse limb events were reported within 2 years. Detailed follow-up data is in Table 1.
CONCLUSIONS: There is limited evidence regarding the use of the common carotid artery as a source of inflow for lower extremity revascularization. Our study demonstrates that, in select patients, this inflow technique can achieve favorable short-term outcomes. Long-term follow-up is limited by the small sample size and the impact of adverse social determinants on our patient population. Standardization of the procedure is challenging due to altered anatomy from prior revascularization attempts. Graft infections remain a significant source of morbidity and mortality, and reconstructive options for these patients are limited. In this context, creative extra-anatomic bypasses may provide a valuable solution.
Table 1: Bypass Patency, Follow-up, and Mortality| Patient Number | 1 Month | 2 Months | 6 Month | 12 Months | 2 Years |
| 1 | Patent | Patent | Lost to Follow-up | Lost to Follow-up | Lost to Follow-up |
| 2 | Patent | Lost to Follow-up | Lost to Follow-up | Lost to Follow-up | Lost to Follow-up |
| 3 | Patent | Patent | Patent | Patent | Deceased |
| 4 | Patent | Patent | Patent | Patent | Patent |
| 5 | Patent | Patent | Patent | Occluded | Lost to Follow-up |
| 6 | Lost to Follow-up | Deceased | Deceased | Deceased | Deceased |
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