Some Technical Aspects of Carotid Endarterectomy Performing

Igor M Ignatyev

Department of Vascular Surgery, Kazan State Medical University, Russia

^*Correspondance to: Igor M Ignatyev 

 PDF  Full Text DOI: 10.25107/2474-1647.2068

Abstract

Background: The aim of this study is to improve Carotid Endarterectomy (CEA) results by developing of techniques of carotid bifurcation reconstruction.Methods: Between January 2012 and December 2017, 1503 patients underwent CEA in the Department of Vascular Surgery, including 461 (31%) according to conventional technique and 1042 (69%) - to eversion technique. The average age of patients was 61,8 ± 9,5. These operations were performed in patients with more than 70% stenoses of the Internal Carotid Artery (ICA). 1449 reconstructions were performed under general anaesthesia, 54- under locoregional anaesthesia. Pre-operative examination included Duplex Ultrasound (DUS), Transcranial Doppler (TCD) and magnetic resonance angiography. 135 (9%) patients underwent eversion CEA (eCEA) method with a prolonged incision on ICA and External Carotid Artery (ECA) formation of “extended” anastomosis between these arteries. CEA with the “Neo Bifurcation” technique by means of Y-shape arteriotomy of Common Carotid Artery (CCA), IСА and EСА was utilized in 60 (4%) patients. In order to prevent floatation of the proximal portion of the atherosclerotic plaque cut in the CCA it was fixed by sutures.
Results: Long-term outcomes (average 25 ± 14 months) of eCEA with the formation of “extended” anastomosis were seen in 69 (51%) patients. No strokes or deaths occurred. A significant restenosis (more than 70% IСА lumen) was observed in two patients. After CEA with the “Neo Bifurcation” there were no damages of cerebral circulation in immediate postoperative period. In long-term period (average 27 ± 15 months) 29 (48%) patients were examined. No strokes or deaths occurred. Restenoses of carotid arteries were not revealed in control DUS.Conclusion: A preliminary marking of carotid bifurcation by DUS allows optimizing the length of access in CEA. A routine use of intra-operative DUS provides the opportunity for revealing floating parts of intima, thrombotic mass and to take actions to eliminate these defects in proper time. The method of the neo bifurcation formation of carotid arteries can be used in their prolonged stenosis lesions. It allows avoiding the use of a prosthetic patch with possible unfavorable consequences (patch infection and aneurysm formation). This method let reduce the time of the main stage of operation substantially.

Keywords

Carotid Endarterectomy; Eversion Endarterectomy; Carotid Artery Bifurcation; Neo Bifurcation Formation; Extended Anastomosis

Cite the article

Ignatyev IM. Some Technical Aspects of Carotid Endarterectomy Performing. Clin Surg. 2018; 3: 2068.