Difficult lesions of the carotid arteries and their surgical management.

We have discussed five lesions that are encounted less commonly than the usual occlusive carotid lesion that occurs at the carotid bifurcation, namely, high lesions, ulcerative plaques, tortuous carotids, carotid aneurysms, and carotid body tumors. Illustrative cases of these lesions were presented. The diagnostic difficulties related to some of them and the technicalaspects of their surgical management were discussed. New techniques for resecting internal carotid aneurysms and carotid body tumors by using autogenous saphenous vein grafts and a shunt were described and illustrated.