A simple method for combined carotid endarterectomy and correction of internal carotid artery kinking

Chino, Eric S.

doi:10.1067/mva.1987.avs0060197

Cited by 23 publications

(5 citation statements)

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“…The arteriotomy routinely extended beyond the carotid bifurcation for more than 2 cm or far beyond the carotid plaque. Argyle shunts (8)(9)(10)(11)(12)(13)(14) Fr) were used to maintain continuous cerebral perfusion. The shunt was secured in place at the common carotid with Rumel tourniquets and tightened with vessel loop at the internal carotid artery.…”

Section: Methodsmentioning

confidence: 99%

Plication for Correction of Excessive Carotid Artery Kinking, Unacceptable Torn End Point, and Perforation from Plaque Erosion: Techniques and Results

et al. 1998

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The purpose of this study was to introduce carotid plication as a simpler alternative approach to internal carotid resection, reimplantation, graft replacement in the management of symptomatic carotid kink, carotid perforation, and unacceptable end point.Fifty-two carotid plications (internal carotid = 49, common carotid = three) were performed on 50 patients (29 men, 21 women) and followed up for 8-129 months (mean 67). Carotid plications were performed for kink (n: 43), carotid perforation from plaque erosion (n: three), and unacceptable end point of endarterectomy (n: six). The operation was performed with 100% shunting and vein patch angioplasty.There was no death, stroke, aneurysm, pseudoaneurysm, rupture, or stenosis in the 52 carotid plications. Symptomatic relief was successful in amaurosis fugax, transient ischemic attack, global ischemia, and vertebral-basilar symptoms. Only partial relief was achieved in carotid throbbing.Carotid plication is a simple, dependable, and durable procedure for symptomatic carotid kink, carotid perforation due to plaque erosion not amendable to lateral repair, and unacceptable distal end point in carotid endarterectomy.

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Section: Methodsmentioning

confidence: 99%

Plication for Correction of Excessive Carotid Artery Kinking, Unacceptable Torn End Point, and Perforation from Plaque Erosion: Techniques and Results

et al. 1998

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“…It has been described that patch reconstruction of the endarterectomized ICA creates a 'ballooning' effect which results in kinking adjacent to the distal end of the patch [11,16]. Although the hemodynamic significance of this observation has not been established, it has been documented by intraoperative angiograms [13]. Theoretically, the increased diameter creates higher tension in the wall of the patched segment making it more 'stiff' and resistant to kinking.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, recent reports indicate that a shortening procedure is needed in 3-21 % of CEAs [9][10][11]. Different techniques have been described for correction of redundant arteries such as resection and patch angioplasty [10,12] or resection and reimplantation [13]. However, a simpler technique was first described in 1967 by Imparato and Lin [14] in which plication and patch angioplasty was used to correct kinking associated with vertebral arterial stenosis.…”

Section: Introductionmentioning

confidence: 99%

Posterior Transverse Plication Technique for Treatment of Redundant Internal Carotid Artery during Endarterectomy

Ascher,

Hingorani,

Gunduz

et al. 2001

Cardiovascular Surgery

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Purpose: Posterior transverse plication (PTP) has gained popularity as a technique to correct redundancy of the internal carotid artery during endarterectomy. The safety of this technique in large series of patients has not been extensively studied. We investigated 876 primary carotid endarterectomies (CEAs) performed at our institution over the last six years to determine the safety of this technique. Methods: Indication for surgery was carotid stenosis ≥ 70% in 341 (39%) symptomatic and 535 (61%) asymptomatic cases. Preoperative imaging consisted of duplex ultrasound alone or combined with magnetic resonance angiography. Patients were divided into four groups related to surgical technique: CEA + PTP + 8 mm patch (group la), CEA + PTP + 10 mm patch (group lb), CEA + patch (group II) and CEA + primary closure (group III). There were 43, 39, 581 and 213 patients in groups la, lb, II and III, respectively. No statistical differences in age, sex or risk factors for atherosclerotic disease were noted among the groups. Postoperative duplex ultrasonography was used at 2 weeks and every 6 months thereafter to evaluate the adequacy of the repair and presence of complications such as pseudoaneurysm formation and extrinsic compression by the excluded carotid segment. Results: The 30-day mortality was 1.2%, 0.6% and 0.3% for groups I, II and III, respectively. Stroke rates for the same period were 0%, 0.6% and 0.8% for groups I. II and III, respectively. Duplex ultrasonography demonstrated significant stenosis (≥ 50%) in two (5%) patients in group la at 12 months. No restenosis was observed in group lb. For groups II and III the rates of restenosis were 1.5% and 0.8%. One patient in group II developed a pseudoaneurysm after 7 months. Conclusion: Posterior transverse plication safely corrects redundancy of the internal carotid artery during endarterectomy without causing early significant restenosis. Continued follow-up in a larger group of patients to determine long-term efficacy and correlation between patch size and restenosis rate is warranted.

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“…8,9 The significance of these spontaneous ICA kinks remains uncertain, although several surgical approaches have been described. [10][11][12][13] Alternatives include (1) a transverse arteriotomy to excise the redundant portion of ICA with suture of the distal ICA to the proximal ICA stump after spatulation of the ends, with the front wall being completed with a patch angioplasty, 12 or (2) a long arteriotomy along the carotid bulb followed by transection of the proximal ICA, which is then brought down to be sutured into the bulb without any portion being excised. 13 Although these patients had symptoms of cerebral ischemia, they did not necessarily have coincident critical ICA stenosis.…”

Section: Discussionmentioning

confidence: 99%

Shortening and reimplantation for tortuous internal carotid arteries

Fearn

McCollum

1998

Journal of Vascular Surgery

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In carotid surgery, reconstructive techniques must be tailored to operative findings. Excision of a tortuous elongated proximal ICA with reimplantation is not associated with additional mortality or morbidity rates over those of conventional CEA alone and has the advantage of removing disease at the bifurcation. This procedure was carried out in 13% of our patients and should be a procedure with which the vascular surgeon is familiar.

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A simple method for combined carotid endarterectomy and correction of internal carotid artery kinking

Cited by 23 publications

References 0 publications

Plication for Correction of Excessive Carotid Artery Kinking, Unacceptable Torn End Point, and Perforation from Plaque Erosion: Techniques and Results

Plication for Correction of Excessive Carotid Artery Kinking, Unacceptable Torn End Point, and Perforation from Plaque Erosion: Techniques and Results

Posterior Transverse Plication Technique for Treatment of Redundant Internal Carotid Artery during Endarterectomy

Shortening and reimplantation for tortuous internal carotid arteries

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