Carotid Endarterectomy: Basic Techniques
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Let's discuss the basic principles for Carotid Endarterectomy, This is a 62 year old male who presented with right sided Tia's and severe carotid stenosis. Such finding is apparent on the CT angiogram. I would like to review the basic principles of incision as well. The anterior edge of the sternocleidomastoid muscle, is the vertical portion of the incision, at the level of the angle of the jaw, the incision turns posteriorly, this configuration of the incision, minimizes the risk of retraction injury to the marginal branch of the facial nerve. I prefer the vertical incision. Facial vein was transected. The internal carotid artery is being exposed. The arteriotomy is completed. I avoid the temptation to wear off midline, during performance of the arteriotomy, a straight linear arteriotomy is mandatory. The arteriotomy should be high enough. So an adequate remove of the plaque, is possible. Next the plaque is carefully dissected, from the lumen of the vessel. The portion of the plaque that enters and extends into the external carotid artery, is also, skeletonized along the poor proximal portion of the external carotid artery. This part of the, plaque is then avulsed. The intimal flaps are, very meticulously dissected. So that, a thrombogenic surface is not, apparent. And put them on irrigation. As is with, identification of the flaps. Next, running, closure was completed since the lumen of the vessel was sizable in this case. During this suturing along the internal carotid artery, the bites of the suture are relatively small, however at the level of the common carotid artery, generous bites are allowed, since the lumen of the vessel, is, very voluminous. Suturing continues from, distal to the middle portion of the arteriotomy similarly from the proximal. Section of the arteriotomy all the way to the level of the middle part of the arteriotomy. Back bleeding, clear as the lumen of the vessel from debris and air, before, flow within the internal carotid artery is restored. For further details, please refer to the text. And the corresponding chapter for carotid endarterectomy. Back bleeding from internal followed by common, and the proclosure is conducted in standard fashion. Thank you.
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