Improved exposure for carotid endarterectomy

Dardik, Herbert; Orozco, Vicente; Hessler, Lindsay K.; Gasparyan, Anna

doi:10.1016/j.jvs.2012.05.076

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Proponents of the technique advice that with the increase in the subplatysmal flap, the use of self-retaining retractors as well as natural laxity of the neck skin is generally possible to gain additional cephalad or caudal exposure as needed [12,14,18]. Recent reports describe the use of specialized ring retractor systems in enabling mini-incision CEA [19,20]. In our practice, a pair of self-retaining retractors (such as a Travers retractor) is used, which enables re-orientation of the subplatysmal portion of the wound to a horizontal direction, thereby achieving a similar exposure to that with a longitudinal skin incision.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after Transverse-Incision ‘Mini’ Carotid Endarterectomy and Patch-Plasty

Sinha

Fok

Goh

et al. 2019

VSI

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PurposeTraditional exposure for carotid endarterectomy (CEA) involves making a longitudinal incision parallel to the anterior border of the sternocleidomastoid. Such incisions can be painful, aesthetically displeasing, and associated with a high incidence of cranial nerve injury (CNI). This study describes the outcomes of CEA performed through small (<5 cm long), transversely oriented incisions located directly over the carotid bifurcation, as identified by color-enhanced Duplex ultrasound.Materials and MethodsPatient demographics and operative data were collected retrospectively from an in-house database of consecutive vascular patients undergoing CEA with a small transversely oriented incision for both symptomatic and asymptomatic carotid artery stenoses.ResultsA total of 52 consecutive patients underwent CEA between 2012 and 2016 (median age, 73.5 years; interquartile range, 67–80.3; male/female ratio, 40:12). CEA was performed under regional/local anesthesia (LA) in 48 (92.3%) patients, with 4 (7.7%) being performed under general anesthesia. One patient under LA experienced neurological dysfunction intraoperatively (manifesting as an inability to count out loud) that resolved with insertion of shunt. One patient experienced a transient neurological event (expressive dysphasia) within the immediate postoperative period, which resolved within 6 hours. No in-hospital death or perioperative major adverse cardiovascular events were noted. No persistent CNIs nor bleeding complications necessitating re-exploration were reported. Follow-up data were available for a median period of 3.1 years and for all patients. Three patients experienced strokes following discharge (2 strokes contralateral to and 1 transient ischemic attack ipsilateral to the operated side).ConclusionSmall, transversely orientated incisions, hidden within a neck skin crease can be safely performed in the majority of patients undergoing CEA.

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Section: Discussionmentioning

confidence: 99%

Outcomes after Transverse-Incision ‘Mini’ Carotid Endarterectomy and Patch-Plasty

Sinha

Fok

Goh

et al. 2019

VSI

View full text Add to dashboard Cite

show abstract

“…This was facilitated with a special retractor designed for this purpose. 1 Division of the posterior digastric belly allowed careful dissection of the aneurysm from behind the jaw, at which point the tortuosity of the ICA aneurysm inflow and outflow was truly appreciated ( C ). This tortuosity proved advantageous, because once the patient demonstrated tolerance of carotid clamping, the aneurysm was resected with ample healthy common ICA remaining to perform an end-to-end anastomosis.…”

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confidence: 99%