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

Abstract

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.

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

“…To decrease neurologic deficits and improve cosmetic effects, some centers have used minimal longitudinal incisions in a conventional manner, with or without sonographic assistance [2,6]. Furthermore, transverse incisions camouf laged in a skincrease have also been investigated [3,[7][8][9]. Studies of vertical incisions in CEA have shown that a minimal incision causes fewer local neurologic complications than a conventional incision, but no statistical differences have been observed in the incidence of stroke and death [2,6,10].…”

“…To decrease neurologic deficits and improve cosmetic effects, some centers have used minimal longitudinal incisions in a conventional manner, with or without sonographic assistance [ 2 , 6 ]. Furthermore, transverse incisions camouflaged in a skin-crease have also been investigated [ 3 , 7 - 9 ].…”

“…Conventional incisions have been reported to result in a high incidence of local neurologic complications and unsatisfactory cosmetics [ 3 , 11 - 13 ]. Transverse incisions have been studied as an alternative at several centers to decrease rates of CCN injuries and stroke and to achieve better cosmetic results.…”

“…The conventional incision in CEA is approximately 10−15 cm along the anterior border of the sternocleidomastoid muscle (SCM) [ 1 , 2 ]. Some studies have suggested that larger incisions result in higher rates of cranial and cervical nerve (CCN) injuries involving the hypoglossal, vagus, transverse cervical, great auricular, and facial (mandibular branches) nerves [ 3 ].…”

Complications of Modified Radical Neck Dissection in Patients at Tertiary Care Hospital

“…This is the key area for wound breakdown that is why it is important to achieve good hemostasis and carefully suturing the wound. Trifurcations or incisions parallel to carotid artery should be avoided to minimize wound breakdown 18 . Additionally, skin flaps should be elevated in the sub-platysmal plane in order to maximize the blood supply.…”