Internal Jugular Vein Interposition Bypass for an Attigah Type II Extracranial Internal Carotid Artery Aneurysm: A Case Report of an Underused Autologous Conduit.

INTRODUCTION: Extracranial internal carotid artery aneurysms are uncommon and may cause cerebral ischaemia through embolisation or thrombosis. Attigah type II aneurysms require complex exposure, and conventional reconstruction options include saphenous vein grafts, prosthetic conduits, or arterial transposition. The use of the internal jugular vein (IJV) as an autologous conduit for a carotid aneurysm repair is rarely described in the literature. A case of a successful repair using this conduit is reported. REPORT: A 69 year old man presented with a progressively enlarging right cervical mass. Computed tomography angiography demonstrated a 22 × 31 mm Attigah II extracranial internal carotid artery aneurysm with mural thrombus. An open repair was performed. After high cervical exposure and control of the carotid vessels, the external carotid artery was ligated, and the aneurysm was resected under shunting. A reversed ipsilateral IJV segment was used as an interposition graft, as bilateral great saphenous vein mapping showed inadequate diameters. Post-operative recovery was uneventful except for transient vocal cord paresis. No venous congestion developed despite IJV ligation. Duplex ultrasound at one and six months and computed tomography angiography at one year confirmed graft patency without stenosis. DISCUSSION: The IJV provides favourable calibre matching, wall characteristics, and harvest through the same cervical incision. This case demonstrates its feasibility as an autologous conduit when traditional options are unsuitable. IJV interposition may be considered a viable option for reconstructing complex Attigah II aneurysms.