Carotid Endarterectomy: Principles and Technique

by Loftus; Christopher M.

• ISBN13: 9780824728328
• ISBN10: 0824728327
• Edition: 2nd
• Format: Hardcover
• Copyright: 2006-09-21
• Publisher: CRC Press

Summary

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.

Author Biography

Christopher M. Loftus is Professor and Chair of Neurosurgery at Temple University School of Medicine, Philadelphia, Pennsylvania

Table of Contents

Preface to the Second Edition	v
Historical Perspective on Carotid Reconstruction	1	(60)
Scientific Foundation for Carotid Artery Reconstruction	2	(15)
Asymptomatic Carotid Disease	3	(5)
Symptomatic Carotid Disease	8	(4)
Clinical Evaluation	12	(1)
Special Surgical Considerations	13	(4)
Technical Considerations	17	(13)
Anesthesia Choice	17	(3)
Monitoring Techniques During Carotid Cross-Clamping	20	(9)
Arteriotomy Techniques	29	(1)
Surgical Technique of Cervical Carotid Reconstruction	30	(7)
Indications	30	(1)
Preoperative Studies and Preparation	31	(1)
Surgical Technique	31	(6)
Special Considerations	37	(2)
Microsurgical Endarterectomy	37	(1)
Bilateral Carotid Endarterectomy	38	(1)
Complete Occlusion	38	(1)
Acute Stroke	39	(1)
Postoperative Considerations	39	(1)
Complications of CEA	40	(2)
Endovascular Treatment of Carotid Stenosis	42	(4)
References	46	(15)
Radiographic Studies	61	(44)
Low Bifurcation of the Carotid Artery with Symptomatic Plaque Just at the Origin of the Internal Carotid Artery	62	(2)
High Bifurcation of the Cervical Carotid Artery	64	(2)
Side by Side	66	(2)
Focal Internal Carotid Artery Ulcer	68	(2)
Deep Ulceration of a Carotid Plaque	70	(2)
Benign Arteriogram---Bad Ulceration	72	(2)
Ninety-Five Percent Lesion	74	(2)
Extensive Plaque in Common Carotid Artery with Long Arteriotomy	76	(2)
String Sign	78	(2)
X-Ray Identification of an Ascending Pharyngeal Artery Originating at the Carotid Bifurcation	80	(2)
Tandem Stenosis	82	(2)
Cross Filling into Contralateral Middle Cerebral Artery	84	(2)
Can We Predict the Need for Shunting?	86	(2)
Preoperative External Carotid Artery Occlusion	88	(2)
Internal Carotid Stump	90	(2)
Carotid Kink	92	(2)
Carotid Stenosis with Distal Cervical Aneurysm	94	(2)
Intraluminal Thrombus	96	(2)
Complication---Clot Along Suture Line	98	(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