Carotid Endarterectomy: Principles and Technique by Christopher M. Loftus

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By Christopher M. Loftus

With 50% new photographs and an unlimited number of present medical instances, this resource offers an abundance of colour photos and gives illustrative sections at the patch graft strategy, recurrent sickness, advanced and weird carotid surgical procedures, and discussions of carotid issues and their treatments. As within the First version, colour photos are observed via line drawings of significant constructions and a facing-page author's statement at the intricacies of particular concepts via an skilled carotid healthcare professional.

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Example text

The external and internal carotid ties are merely secured with mosquito clamps. Particular attention is paid to the superior thyroid artery, which is dissected free and secured with a double-loop 00 silk ligature. A hanging mosquito clamp keeps tension on this occlusive Potts tie. Occasionally multiple branches of this artery are identified on the preoperative angiogram, and these must be individually managed so that no troublesome back-bleeding will ensue during the procedure. It is also essential that the external carotid silk tie (and subsequent cross clamp) be placed proximal to any major external branches lest unac- ceptable back-bleeding should occur during the arteriotomy and repair.

Schneider et al. H7 reported a similar statistically significant ability to predict decreased MCA velocities and shunt need in a somewhat smaller series of 23 patients. Sufficient experience with TCD monitoring now exists to allow the technique to be compared with other methods of intraoperative carotid endarterectomy monitoring. A number of articles have compared TCD monitoring with intraoperative stump pressure measurements, customarily using a stump pressure of less than 50 mm Hg as an indication for shunting.

IID In light of the ACAS data, I most likely will follow up postoperative patients for longer periods. 16 Concurrent Coronary/Carotid Disease It is well established that patients with extracranial carotid artery disease have a higher than normal incidence of coronary disease along with other peripheral vascular problems. Indeed, the risk of perioperative MI exceeds the risk of perioperative stroke in many clinical series of carotid endarterectomy. Several major questions arise when planning treatment for concurrent coronary/carotid disease.

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