Techniques in carotid artery surgery

Curtis, Jonathan Andrew; Johansen, Kaj

doi:10.3171/foc/2008/24/2/e18

Cited by 14 publications

(4 citation statements)

References 78 publications

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“…Although CEA is very common and has been performed for more than 50 years, 9 the specific surgical technique is variable from surgeon to surgeon with respect to the use of general or local anesthesia, eversion or conventional endarterectomy, use of intraoperative shunt and carotid artery patching. [10][11][12][13] In addition, there is no agreement on the appropriate orientation of the surgical incision. The standard operative approach uses an incision oriented parallel with the anterior border of the sternocleidomastoid muscle.…”

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confidence: 99%

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

Deck

Kopriva

2015

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Background: Carotid endarterectomy (CEA) is a very common operation, but there is no agreement on the appropriate orientation of the surgical incision. Methods:We retrospectively reviewed the charts of patients who had undergone CEA between Jul. 1, 2010, and Dec. 31, 2013. We contacted patients identified in the review to solicit participation in a clinical follow-up examination, during which the esthetic outcome of the scar was evaluated using the Patient and Observer Scar Assessment Scale (POSAS).Results: During the study period 237 CEAs were performed. Nine patients refused the use of their personal health information in this study. There were no significant differences in the neurologic outcomes of patients based on the incision orientation (perioperative stroke and death 1.4% with transverse incision v. 0% with a vertical incision, p = 0.44). Fifty-two patients presented for follow-up examination. Thirty-three had a transverse incision and 19 had a vertical incision. Results of the POSAS significantly favoured the transverse incision (p = 0.03). Vertical incisions were more often associated with persistent, mild marginal mandibular nerve dysfunction (p = 0.04). Conclusion:Carotid endarterectomy performed through a transverse skin incision compared with a vertically oriented skin incision is associated with improved esthetic outcome, as measured by the POSAS, without an observed statistically significant difference in the risk of perioperative stroke or death between the 2 techniques.Contexte : L'endartériectomie de la carotide est une intervention chirurgicale très courante. Toutefois, il n'existe aucun consensus sur l'orientation de l'incision.Méthodes : Nous avons analysé rétrospectivement les dossiers de patients ayant subi une endartériectomie de la carotide entre le 1 er juillet 2010 et le 31 décembre 2013. Nous avions communiqué au préalable avec les patients concernés pour solliciter leur participation à un examen de suivi clinique au cours duquel le résultat esthétique de leur cicatrice serait évalué au moyen de l'échelle d'évaluation des cicatrices par les patients et les observateurs (POSAS).Résultats : Au cours de la période visée, 237 endartériectomies de la carotide ont été pratiquées. Neuf patients ont refusé qu'on utilise leurs renseignements médicaux personnels dans le cadre de l'étude. Aucune différence significative n'a été observée quant aux capacités neurologiques des patients selon l'orientation de leur incision chirurgicale (décès et accident vasculaire cérébral périopératoires : 1,4 % avec incision transversale contre 0 % avec incision verticale, p = 0,44). Au total, 52 patients se sont présentés pour un examen de suivi : 33 avaient eu une incision transversale et 19, une incision verticale. Les résultats à la POSAS étaient nettement meilleurs pour les incisions transversales (p = 0,03). Les incisions verticales étaient plus souvent associées à un dysfonctionnement léger, mais persistant de la branche marginale de la mandibule du nerf facial (p = 0,04). Conclusion :Notre étude indique...

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confidence: 99%

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

Deck

Kopriva

2015

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“…This was a technical problem that would not have improved with anticoagulation and would need to be repaired regardless of the symptomatic status. In the past, we have treated these patients with reoperation and often have found that this complication can be either treated or avoided altogether through the usage of circumferential, vertically oriented tack-up sutures using 6-0 prolene at the site where the distal plaque is fractured from the intima 10 11. The decision on open versus endovascular treatment in this case was both technical and practical.…”

Section: Discussionmentioning

confidence: 96%

Acute carotid stenting for treatment of stuttering transient ischemic attacks after recent carotid endarterectomy

Doss

Arthur²,

Watridge³

et al. 2013

BMJ Case Reports

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Carotid endarterectomy (CEA) is the established standard to treat occlusive extracranial atherosclerotic carotid disease. Complications of CEA must be recognized and dealt with efficiently due to the potentially catastrophic neurologic sequelae. A 67-year-old African American man was transferred from an outside hospital for an acute stroke. He had initially presented with a small right frontal subcortical infarct and had undergone a right CEA 2 days prior to transfer. He had a fluctuating examination with left-sided hemiplegia to slight hemiparesis and inconsistent neglect. Head CT demonstrated a watershed infarct of the right hemisphere. CT angiography demonstrated high grade stenosis at the distal aspect of the CEA anastomosis. He was promptly taken for angiography and underwent acute stenting of the right internal carotid artery. This case demonstrates that carotid artery stenting is a safe management strategy for the treatment of complications associated with failed distal anastomosis during CEA.

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“…These are eversion and conventional CEA. 16 It has been shown that any incision applied to the vessel wall causes some degree of fibrosis as a natural part of the healing process, and this occurs despite the most meticulous care and use of fine suture materials. 17 In some instances, even vascular plasty techniques or the use of patch materials may result in restenosis due to vascular incisions.…”

Section: Experience Of 352 Carotid Endarterectomy Cases Operated On Wmentioning

confidence: 99%

Experience of 352 Carotid Endarterectomy Cases Operated on without Any Shunt and a Technical Modification: Thirty-Day Results

Okur¹,

Akpınar²,

Uyar³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The necessity for an indwelling arterial shunt during carotid endarterectomy (CEA) is one of the most widely debated and long-standing controversies in carotid surgery. We developed a modified technique for carotid endarterectomy without using a shunt and have achieved successful results with this procedure. The aim of this study is to present these 352 isolated CEA cases and evaluate the results. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : In our clinic, 352 isolated CEA were performed on 320 consecutive patients without using a shunt between 2005 and 2012. In 32 of the cases, bilateral CEA were performed. Among the patients, 36.8 % (n=118) were neurologically asymptomatic, and 63.2 % (n=202) were symptomatic. Complete occlusion was present in the contralateral carotid arteries of 23 patients. All patients were operated on under general anesthesia, and no intraluminal shunts were used. This operative technique is a modification of an eversion carotid endarterectomy in which a longitudinal arteriotomy is begun on the common carotid artery (CCA) and purposely skewed towards the origin of the external carotid artery. The mean crossclamp time in our study was 12±4.62 minutes. R Re es su ul lt ts s: : There was one case of postoperative mortality (0.28%) that was caused by myocardial infarction. We observed 1 (0.28%) case of permanent neurologic deficit, 27 (7.6%) cases of peripheral nerve damage, 4 (1.1%) cases of early postoperative transient neurologic attack, 3 (0.85%) cases of hoarseness and 3 (0.85%) cases of neurocognitive impairment. C Co on nc cl lu us si io on n: : The results indicate that this mini-modified eversion CEA surgery performed without the use of a shunt can be successful for patients with carotid stenosis. K Ke ey y W Wo or rd ds s: : Endarterectomy, carotid; ischemic attack, transient; stroke Ö ÖZ ZE ET T A Am ma aç ç: : Karotis arter endarterektomi (CEA) cerrahisinde şant kullanım gerekliliği, yama kullanımı, eversiyon ve konvansiyonel endarterektomi teknikleri halen tartışılan konulardır. Kliniğimizde CEA operasyonları şant kullanılmadan yapılmaktadır. Yine bu operasyonlarda kliniğimizde geliştirilmiş olan farklı bir arteriyotomi tekniği kullanılmaktadır. Bu çalışmada şant kullanılmadan gerçekleştirilen 352 izole CEA olgusu değerlendirilmiş ve kliniğimizce geliştirilmiş olan tekniğinin tarifi ve erken dönem sonuçları tartışılmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Kliniğimizde 2005-2012 yılları arasında 320 hastaya 32'si bilateral olmak üzere, toplam 352 izole CEA operasyonu uygulandı. Hastaların %36,8 (n=118)'i nörolojik olarak asemptomatik, %63,2 (n=202)'si ise semptomatik hastalardan oluşmaktaydı. Tüm hastalar genel anestezi altında ve şant kullanılmadan opere edildi. Endarterektomi, ana karotis arterden eksternal karotis artere longitudinal bir arteriyotomi insizyonu ile gerçekleştirildi. Ortalama kros klemp zamanı 12±4,62 dakika olarak ölçüldü. B Bu ul lg gu ul la ar r: : Genel anestezi altında...

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Techniques in carotid artery surgery

Cited by 14 publications

References 78 publications

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

Acute carotid stenting for treatment of stuttering transient ischemic attacks after recent carotid endarterectomy

Experience of 352 Carotid Endarterectomy Cases Operated on without Any Shunt and a Technical Modification: Thirty-Day Results

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