SURGICAL ACCESS TO THE THIRD SEGMENT OF THE VERTEBRAL ARTERY

Today V3 is the rarest and most difficult to access segment of vertebral artery (VA). Material methods. A sectional study was performed in 35 patients who died from various causes topographic anatomical characteristics VA anatomy V3. The technique VA: along inner edge right sternocleidomastoid muscle, a linear incision 6.2+1.5 cm long performed, starting level 2.1+0.8 above angle lower jaw submandibular fold towards «tragus» auricle. common carotid artery, internal (ICA), jugular vein, external up third were isolated with excision ligation lateral branches. dissection salivary gland not carried out, since it quite mobile well retracted by retractor hooks, as venous plexus, nerves, «digastric» muscle. Results. original approach proposed us suggests reducing surgical trauma, risk developing damage neurovascular structures intervention zone. When working on material, distance between distal portion ICA determined. It did exceed, according our data, 3.2+2.1 mm. This fact allows, if necessary, safely form an anastomosis «side-to-side» type. Conclusions. enables reduction trauma length 6.2+1.2 cm, mobilizing wound without crossing them (salivary gland, vagus nerve, C2 - brachial digastric artery). With concomitant tortuosity ICA, excess part optimal material for bypassing VA. variant correction this situation formation «trifurcation» artery.