Symptomatic Improvement after Surgical Transposition of an Extremely Medialized Carotid Artery Causing Swallowing Discomfort: A Case Report

An aberrant course of the carotid artery can cause dysphagia by displacing the pharynx, but no definitive treatment strategy has been established for this condition. We report a case in which swallowing discomfort was improved by surgical transposition of a carotid artery following a highly medial course. A 79-year-old man presented with worsening swallowing discomfort over the preceding year. Computed tomography angiography of the head and neck showed tortuous right common and internal carotid arteries running through the retropharyngeal space. Videoendoscopic and videofluorographic examinations revealed intact swallowing function and the carotid artery compressing the right pharyngeal wall. Since the cause of swallowing discomfort was suspected to be the tortuous courses of the right common and internal carotid arteries, we performed surgery to change the course of the carotid artery. The surgical procedure moved the common and internal carotid arteries from the retropharyngeal space. The carotid artery was retracted anterolaterally with the carotid sheath, which was fixed to the sternocleidomastoid muscle to maintain the corrected course. Symptoms showed immediate improvement postoperatively. Our strategy appears effective as a method of treating swallowing discomfort due to tortuosity of the carotid arteries.