Total carotid occlusion may involve chronic occlusion as a result of chronic arterial disease caused by arteriosclerosis or acute occlusion caused by artificially induced permanent closure of the carotid artery. We report our experience of reconstruction of the head and neck region in four patients with carotid occlusion. Two cases involved secondary reconstruction for esophageal deficit following rupture of the carotid artery after surgery for esophageal cancer. Two cases involved primary reconstruction for palate cancer in one case of chronic carotid occlusion and for cervicothoracic esophageal carcinoma in a case of subclavian artery occlusion. In the case of acute occlusion, there was rich blood flow in the carotid artery branches due to the collateral circulation via the circle of Willis; therefore the graft bed blood vessels were fully utilized. In the case of chronic occlusion, the collateral flow is complex and diverse, and almost impossible to identify. Since the collateral pathway may be the main artery for important organs, caution has to be exercised. In the case of chronic occlusion, use of the graft bed vessels on the side of occlusion should be avoided as far as possible.
