Northwest Medical Cardiac & Vascular Center, Margate, FL.
BACKGROUND: To demonstrate a novel and simple carotid endarterectomy technique that results in a shorter procedure, decreased recovery time, lesser risk of complications and significant cost reduction.
METHODS: This procedure consists of a mini-arteriotomy (12-14mm long) on the front wall of the internal carotid's widest origin "without" transecting the artery completely as in the classical eversion technique.
Eversion endarterectomy is done from below the bifurcation distally into the external and internal simultaneously.
There are several advantages:
a. The back wall of the artery remains intact, therefore less chances of suture line proliferation or recurrence.
b. Easy to prolong arteriotomy and correct a questionable distal endpoint (contrary to the standard complete transection)
c. Avoid prosthetic patch preventing infection, pseudoaneurysm, or suture-line bleeding
d. Significant reduced clamping time
e. Considerable reduction in the cost of OR time, anesthesia, PACU and LOS
Our choice is general anesthesia with local infiltration. We no longer perform the classical complete transection and eversion endarterectomy after gaining experience and success with our technique.
RESULTS: During the last 3 years, we selected 100 patients for this procedure. Every patient woke up immediately from the anesthesia without neurological deficits, hematomas, nerve injuries or cardiac complications. Overall, the perioperative results are excellent.
CONCLUSIONS: This approach is feasible, safe, simple and an effective method of intervention for carotid reconstruction.
AUTHOR DISCLOSURES: M. Avila: Nothing to disclose.
Posted April 2013