Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#3 INTRAOPERATIVE COLOR DOPPLER IMAGING AFTER CAROTID ENDARTERECTOMY
Donald P. Spadone, MD, Jose L. Almeida, MD, John G. Calaitges, MD, Timothy K. Liem, MD, W. Kirt Nichols, MD and Donald Silver, MD The University of Missouri-Columbia, Columbia, MO
Continuous wave Doppler interrogation or angiography has traditionally been used as an intraoperative completion study (IOCS) after carotid endarterectomy (CEA). The development of a small footprint color Doppler probe has made it possible to easily obtain high-resolution intraoperative imaging. Over the past couple of years, color Doppler imaging (CDI) has gradually replaced angiography as the primary method of IOCS in our group. CDI has many advantages for an IOCS after CEA; the technique is inexpensive, rapid, produces high quality images, is easy to learn, and does not use ionizing radiation. Over the past 12 months, a total of 105 carotid endarterectomies (CEA) were performed with CDI as an IOCS. There was only one minor stroke. The operating surgeon performed all the ultrasonic imaging. The arterial repair was viewed in sagittal and transverse planes, with and without color Doppler. Intimal flaps were identified by: 1) an increase in velocity at the endpoint of the endarterectomy, 2) visualization on B-mode, and 3) the flow abnormality seen in the CDI flow stream. The decision to reopen the artery was made by the operating surgeon. Criteria for an abnormal scan included: 1) a mobile intimal flap, 2) a flap that extended >25% into the diameter of the artery, 3) an intraluminal filling defect, and 4) elevated velocities at the CEA endpoint. Patients with internal carotid shunts were considered to have a significant residual stenosis if the peak systolic velocity (PSV) was >150 cm/sec. Patients who did not have shunts (cervical block) had temporary elevation of the PSV secondary to hyperemic flow after re-establishing internal carotid artery flow. A PSV of >200 in these patients was considered abnormal. There was a trend toward reduction of the stroke, death, and restenosis rate in the postoperative period. We attribute, in part, these improved operative results to the detection and correction of technical flaws discovered by CDI. Examples of IOCS technical errors seen by CDI will be presented.
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Last updated January 10, 1999