Can the External Carotid Artery Be Securely Ligated using the BRIG Technique in the Treatment of Carotid Disease?

Philippe De Vleeschauwer, Thomas Van den Broeck, Steven Vissers, Johan Debeuf, Koen De Feyter and Peter Waets

Department of Thoracic Vascular Surgery, Heilig Hart Ziekenhuis, Lier, Belgium
Department of Urology, University Hospitals Leuven, Leuven, Belgium
Department of Anesthesiology, Heilig Hart Ziekenhuis, Lier, Belgium

^*Correspondance to: Philippe De Vleeschauwer 

 PDF  Full Text DOI: 10.25107/2474-1647.2073

Abstract

Introduction: Ligating the external carotid artery during carotid artery surgery remains a debatable act for many surgeons due to the potential impact of facial arterial blood supply. However, in our previous report on the BRIG technique to treat carotid disease, only one patient developed jaw claudicating and no other symptoms of facial hypo-perfusion. The goal of this study is to scientifically substantiate these clinical findings by determining the impact of interruption and restoration of the carotid blood flow on the External Carotid Artery Stump Pressure (ECASP).Methods: A prospective proof-of-concept study was performed, including nine consecutive patients who underwent BRIG surgery for symptomatic ICA stenosis or asymptomatic high grade ICA stenosis. A Javid shunt was used to measure the ECASP and the CASP during the procedure. An arterial line was used to measure systemic blood pressure. To compare the ECASP during clamping and after the restoration of ICA blood flow, multiple Students’ T-testing was performed, correcting for multiple testing using the Holm-Sidak method.Results: ECASP and ECASP /BP index did not significantly change during clamping of the carotid bifurcation and after restoration of cerebral blood. Both CASP and ECASP did not change significantly during clamping of the common carotid artery.Conclusion: The internal carotid artery does not influence the ECASP and no high blood pressure needs to be present in the ECA for it to be functional. Based on these findings, we can conclude that the ECA can be safely ligated during the BRIG procedure.

Keywords

Carotid artery; Carotid disease; ECASP

Cite the article

De Vleeschauwer P, Van den Broeck T, Vissers S, Debeuf J, De Feyter K, Waets P. Can the External Carotid Artery Be Securely Ligated using the BRIG Technique in the Treatment of Carotid Disease? Clin Surg. 2018; 3: 2073.