Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#6 EVERSION ENDARTERECTOMY OF THE INTERNAL CAROTID ARTERY: EARLY RESULTS OF A SELECTIVE APPROACH
Gary A. Fantini, M.D. New York, NY
Eversion endarterectomy of the internal carotid artery (ICA) represents a simple and elegant method of disobliteration of carotid bifurcation atheroma. The ICA is transected in oblique fashion at its origin, eversion endarterectomy performed, common and external carotid endarterectomy carried out as needed, and the ICA reattached to its origin. Eversion endarterectomy of the ICA was adopted as the preferred approach to disobliteration of carotid bifurcation atheroma in September of 1995.
Through December of 1997, 55 carotid endarterectomies were performed, 41 by eversion and 14 by conventional longitudinal arteriotomy with dacron patch angioplasty. The latter procedure was utilized only in instances of redo endarterectomy for recurrent stenosis (4), when shunt use was mandated by mental status changes under cervical block (1), or in the setting of unstable neurologic symptoms preoperatively (3), or when hemodynamically significant atheroma extended proximal to the distal common carotid artery (6). Cervical block was utilized in 48 patients and general anesthesia in 7 patients. Thirty-one patients were asymptomatic, with ICA stenosis of > 70%. Of the symptomatic patients, 6 had hemispheric TIA, 5 retinal TIA, 5 global ischemic symptoms, 3 nondisabling stroke, 2 retinal stroke and 3 unstable neurologic symptoms. There were no perioperative strokes. There was one death in an 83 year old man with recent nondisabling stroke and hepatocellular carcinoma. There was one intracranial hemorrhage with complete recovery, and one reoperation for evaculation of neck hematoma. One patient developed recurrent 90% stenosis at the origin of the ICA 18 months after eversion endarterectomy, which was asymptomatic. Reoperation by conventional logitudinal arteriotomy with dacron patching was performed.
Eversion endarterectomy of the ICA is a technically simple operation and is well suited for lesions confined to the ICA and Bifurcation. It is particularly useful when ICA redundancy necessitates shortening and in long lesions where the atheroma extends into the distal ICA. This method was not used when a shunt was required, due to concern regarding shunt placement across the distal endpoint after eversion.
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Last updated January 10, 1999