Carotid Endarterectomy: Principles and Technique

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ISBN: 9780824728328 | 0824728327
Cover: Hardcover
Copyright: 9/21/2006

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With 50% new photos and a vast selection of current clinical cases, this source supplies an abundance of color images and provides illustrative sections on the patch graft technique, recurrent disease, complex and unusual carotid surgeries, and discussions of carotid complications and their remedies. As in the First Edition, color photographs are accompanied by line drawings of important structures and a facing-page author's commentary on the intricacies of specific techniques by an experienced carotid surgeon.

Preface to the Second Edition

Historical Perspective on Carotid Reconstruction

(60)

Scientific Foundation for Carotid Artery Reconstruction

(15)

Asymptomatic Carotid Disease

(5)

Symptomatic Carotid Disease

(4)

Clinical Evaluation

(1)

Special Surgical Considerations

(4)

Technical Considerations

(13)

Anesthesia Choice

(3)

Monitoring Techniques During Carotid Cross-Clamping

(9)

Arteriotomy Techniques

(1)

Surgical Technique of Cervical Carotid Reconstruction

(7)

Indications

(1)

Preoperative Studies and Preparation

(1)

Surgical Technique

(6)

Special Considerations

(2)

Microsurgical Endarterectomy

(1)

Bilateral Carotid Endarterectomy

(1)

Complete Occlusion

(1)

Acute Stroke

(1)

Postoperative Considerations

(1)

Complications of CEA

(2)

Endovascular Treatment of Carotid Stenosis

(4)

References

(15)

Radiographic Studies

(44)

Low Bifurcation of the Carotid Artery with Symptomatic Plaque Just at the Origin of the Internal Carotid Artery

(2)

High Bifurcation of the Cervical Carotid Artery

(2)

Side by Side

(2)

Focal Internal Carotid Artery Ulcer

(2)

Deep Ulceration of a Carotid Plaque

(2)

Benign Arteriogram---Bad Ulceration

(2)

Ninety-Five Percent Lesion

(2)

Extensive Plaque in Common Carotid Artery with Long Arteriotomy

(2)

String Sign

(2)

X-Ray Identification of an Ascending Pharyngeal Artery Originating at the Carotid Bifurcation

(2)

Tandem Stenosis

(2)

Cross Filling into Contralateral Middle Cerebral Artery

(2)

Can We Predict the Need for Shunting?

(2)

Preoperative External Carotid Artery Occlusion

(2)

Internal Carotid Stump

(2)

Carotid Kink

(2)

Carotid Stenosis with Distal Cervical Aneurysm

(2)

Intraluminal Thrombus

(2)

Complication---Clot Along Suture Line

(2)

Complication---Complete Postoperative Occlusion

100

(2)

Complication---External Carotid Artery Dissection

102

(3)

Surgical Technique

105

(182)

Surgical Instruments

106

(2)

Surgical Positioning

108

(2)

Alternate Incisions

110

(2)

Side-by-Side Positioning

112

(2)

Incision for High Bifurcation

114

(2)

Draped and Ready for Incision

116

(2)

Platysma with Michel Clips

118

(2)

Sternocleidomastoid Muscle

120

(2)

Jugular Vein---Common Facial Vein

122

(2)

Ligation of Common Facial Vein

124

(2)

Secure Ligation of the Common Facial Vein

126

(2)

Minor Branches of Facial Vein

128

(2)

Dissection Behind Parotid Gland

130

(2)

First Demonstration of Common Carotid Artery with Control

132

(2)

Exposure of Carotid Artery with Retractors

134

(2)

Four Sutures in the Carotid Sheath

136

(2)

Unexpected Internal Carotid Artery Atresia

138

(2)

Major Nerve Structures Potentially Injured During Carotid Endarterectomy

140

(2)

Other Nerves at Risk During Carotid Endarterectomy

142

(4)

Low Bifurcation with Omohyoid Muscle

146

(2)

Division of Omohyoid Muscle to Secure Adequate Low Carotid Exposure

148

(2)

Hypoglossal Nerve

150

(2)

Sternomastoid Artery---An External Carotid Artery Branch

152

(2)

High Bifurcation with Digastric Muscle and Hypoglossal Nerve---Left Carotid Exposure

154

(2)

High Bifurcation with Digastric Muscle and Hypoglossal Nerve---Right Carotid Exposure

156

(2)

Side-by-Side Carotid Anatomy---Exposure

158

(2)

Isolation of Superior Thyroid Artery---Right Carotid Exposure

160

(2)

Isolation of Superior Thyroid Artery---Left Carotid Exposure

162

(2)

Isolation of Ascending Pharyngeal Artery (Left)

164

(2)

Isolation of Ascending Pharyngeal Artery (Right)

166

(2)

Tactile and Visual End of Plaque---Left Carotid Exposure

168

(2)

Tactile and Visual End of Plaque---Right Carotid Exposure

170

(2)

Extensive Plaque Erosion into the Adventitial Layer

172

(2)

Javid Clamp Around Internal Carotid Artery

174

(2)

Loftus Shunt Clamps

176

(2)

Placement of Cross-Clamp Below Rummel Tourniquet

178

(2)

Incision Along Common and Internal Carotid Arteries (Blue Line)---Left Carotid Exposure

180

(2)

Potts Scissors Opening---Left Carotid Exposure

182

(2)

Potts Scissors Opening Vessel---Left Carotid Exposure

184

(2)

False Plane Demonstrated with Penfield Retractor---Right Carotid Exposure

186

(2)

Focal Plaque in Proximal Internal Carotid Artery---Left Carotid Exposure

188

(2)

Long, Extensive Common Carotid Artery/Internal Carotid Artery Plaque

190

(2)

Shunt in Common Carotid Artery/Internal Carotid Artery

192

(2)

Initial Placement of Shunt Down Common Carotid Artery

194

(2)

Securing of Shunt in Common Carotid Artery

196

(2)

Bleeding and Evacuation of Shunt Before Placement in Internal Carotid Artery

198

(2)

Placement of Shunt in Distal Internal Carotid Artery

200

(2)

Potential for Intimal Damage from Placement of Shunt

202

(2)

Securing of Shunt in Internal Carotid Artery

204

(2)

Loftus Type Carotid Shunt in Place---Two Views

206

(2)

Evaluation of Shunt Function

208

(2)

Repair with Shunt in Place

210

(2)

Plaque Removal Begins at Lateral Edge---Left Carotid Exposure

212

(2)

Sharp Transection in Common Carotid Artery---Right Carotid Exposure

214

(2)

Plaque Removal from Internal Carotid Artery (Feathered Edge)---Right Carotid Exposure

216

(2)

Plaque Removal from External Carotid Artery---Left Carotid Exposure

218

(2)

Opening of External Carotid Artery---Inadequate Feathering

220

(2)

Opening of External Carotid Artery---Inadequate Feathering

222

(2)

Opening of External Carotid Artery Because of Poor Doppler Signal

224

(2)

Opening of External Carotid Artery---Repair

226

(2)

Completed External Carotid Artery Repair in a Case with Internal Carotid Artery Hemashield Patch

228

(2)

Removal of Fragments in Circumferential Fashion---Right Carotid Exposure

230

(2)

Left Carotoid Endarterectomy---Completed Removal, Sharp Margins

232

(2)

Completed Removal, Sharp Margins---Left Carotid Exposure

234

(2)

Placement of Tacking Sutures in Internal Carotid Artery

236

(2)

Anatomic Variant---Atherosclerotic Web on Posterior Wall of Vessel

238

(2)

Repair Beginning in Internal Carotid Artery---Left Carotid Exposure---No Patch Graft

240

(2)

Microscopic Internal Carotid Artery Repair

242

(2)

Repair Beginning in External Carotid Artery---Right Carotid Exposure---No Patch Graft

244

(2)

Repair of External Carotid Artery---Left Carotid Exposure---No Patch Graft

246

(2)

Second Limb of Repair Coming Up Common Carotid Artery---No Patch Graft

248

(2)

Suture Sequence and Placement of the Hemashield Roof Patch Graft on the Internal Carotid Artery

250

(4)

Removal of Shunt

254

(2)

Tying Together---Evacuation of Air---Right Carotid Exposure

256

(2)

Blunt Needle to Evacuate Air and Debris as Final Step---Patch Graft

258

(2)

Sequence of Clamp Removal at Completion of Arteriotomy

260

(2)

Doppler Examination of Repair---Left Carotid Exposure

262

(2)

Completed Dry Repair Without and With Hemashield Patch Graft

264

(8)

Y-Shaped Suture Line---No Patch Graft

272

(2)

Surgicel on Dry Repair

274

(2)

Closure of Sheath

276

(2)

Closure of Platysma

278

(2)

Skin and Hemovac

280

(2)

Skin Closure

282

(2)

Placement of Saphenous Vein Patch Graft

284

(3)

Complications

287

(12)

Acute Postoperative Internal Carotid Artery Thrombosis

288

(2)

Technique for Exploration of Complete Carotid Occlusion

290

(2)

Use of Fogarty Catheters to Reopen Thrombosed Internal Carotid Artery

292

(2)

Postoperative Wound Hematoma

294

(2)

Aneurysm Formation Four Years Postoperatively

296

(3)

Special Cases

299

(16)

Treatment of Isolated Common Carotid Artery Stenosis

300

(2)

Treatment of ``Stump'' in an Occluded Internal Carotid Artery

302

(4)

Repair and Straightening of a Large Left Carotid Kink

306

(2)

Rapid Recurrence of Stenosis from Myointimal Hyperplasia

308

(2)

Scarring in the Carotid Sheath in a Case of Recurrent Stenosis

310

(2)

Reoperation in a Case Previously Repaired with a Saphenous Vein Roof Patch

312

(3)

Index

315

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Carotid Endarterectomy: Principles and Technique

Summary

Author Biography

Table of Contents

Supplemental Materials