Carotid sheath sternum. The four major structures contained in the carotid sheath are: The carotid artery lies medial to the internal jugular vein, and the vagus nerve is situated posteriorly between the two vessels. In the upper part, the carotid sheath also contains the glossopharyngeal nerve (IX), the accessory nerve (XI), and the hypoglossal nerve (XII), which pierce the fascia of the carotid sheath. The ansa cervicalis is embedded in the anterior wall of sheath. It is formed by "descendens hypoglossi" (C1) and "descendens cervicalis" (C2-C3). The three major fascial layers in the neck contribute to the carotid sheath: the investing fascia,
Carotid endarterectomy carotid arteries are carefully identified, controlled with vessel loops, and clamped. The lumen of the internal carotid artery is opened, and the atheromatous plaque substance removed. The artery is closed using suture and a patch to increase the size of the lumen. Hemostasis is achieved, and the overlying layers closed with suture. The skin can be closed with suture which may be visible or invisible (absorbable). Many surgeons place a temporary shunt to ensure blood supply to the brain during the procedure. The procedure may be performed under general or local anaesthesia. The latter allows for direct monitoring of neurological