Carotid Endarterectomy: Eversion Technique

Abstract

Abstract:The aim of this article is to explain technique of eversion CEA (carotid endarterectomy), as well as to determine that eversion CEA is more effective than conventional CEA. Eversion CEA can be performed in two methods. When atherosclerotic process mostly involves common carotid artery, the procedure should start with common carotid transection, followed by eversion CEA in cranial and than in caudal direction. The final step is reanastomosis. If atherosclerotic process is mostly localized at the internal carotid artery origin, procedure begins with origin transection. The following steps are eversion endarterectomy of the internal carotid artery, then endarterectomy of carotid bifurcation if it is necessary, and reimplantation of the internal carotid artery. There is no obvious consensus that eversion CEA is superior in regard to conventional one. However, eversion CEA is anatomic procedure that reduces ischemic and total operative time, as well as restenosis and false anastomotic aneurysms occurrence during the follow-up period. It excludes the usage of patches and enables simultaneous correction of the joined kinking or coiling. Eversion CEA, performed by an experienced surgeon is safe, effective, and durable procedure.

Carotid Body Baroreceptor Preservation and Control of Arterial Pressure in Eversion Carotid Endarterectomy

“…[1][2][3] The eversion CEA (ECEA), performed by an experienced surgeon, is a safe, effective, and durable procedure, with many advantages: the carotid bifurcation is preserved, there is no necessity of patch, and the correction of any joined ICA kinking or coiling is feasible, while the total operative time is reduced as well as the occurrence of postoperative restenosis or formation of false anastomotic aneurysms. 3,4 However, upon a successful ECEA, postoperative hypertension has been observed. These evidenced post-ECEA high levels of the arterial blood pressure (BP) have been associated with multiple and severe complications and the phenomenon is attributed to the poor functionality of the baroreceptor mechanism.…”