scholarly journals Carotid Endarterectomy with Routine Shunting: Bloodless and Safe Surgical Procedure, and Outcome

2021 ◽  
Vol 49 (3) ◽  
pp. 200-205
Author(s):  
Kenji SUMI ◽  
Tohru MIZUTANI ◽  
Tatsuya SUGIYAMA ◽  
Kazuki IIZUKA ◽  
Minako KUBO ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Surgical Procedure

scholarly journals Carotid Endarterectomy Without Indwelling Shunts and Intraoperative Electrophysiologic Monitoring

1987 ◽  
Vol 14 (2) ◽  
pp. 131-135 ◽  
Author(s):  
Kesava Reddy ◽  
Michael West ◽  
Brian Anderson
Keyword(s):  
North America ◽  
Mortality Rate ◽  
Prospective Study ◽  
Carotid Endarterectomy ◽  
Surgical Procedure ◽  
Eeg Monitoring ◽  
Satisfactory Outcome ◽  
A Prospective Study ◽  
Cerebral Monitoring

Abstract:Although carotid endarterectomy is a common surgical procedure in North America, controversies exist regarding the type of anesthesia, the use of indwelling shunts and the need for intraoperative cerebral monitoring. We present a prospective study of 100 carotid endarterectomies performed over a three year period by a single surgeon without the use of indwelling shunts, patch grafts, or EEG monitoring. The combined stroke and mortality rate was 1%. Our results confirm those of other authors; that indwelling shunts and EEG monitoring are not absolutely essential for a satisfactory outcome in carotid endarterectomies.

Carotid Cross-Clamp intolerance during carotid endarterectomy in regional anesthesia

2021 ◽  
Vol 29 (1) ◽  
pp. 66-72
Author(s):  
Payman Majd ◽  
Peter Galkin ◽  
Mahmoud Tayeh ◽  
Thomas Herzmann ◽  
Michael Gores ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Surgical Procedure ◽  
Systolic Arterial Pressure ◽  
Tolerance Test ◽  
External Carotid ◽  
Cerebrovascular Events ◽  
History Of

During surgical endarterectomy, carotid cross clamping is needed for arteriotomy and plaque removal. Carotid cross clamping reduces the blood flow to the circle of Willis, and some patients show intolerance to the temporary occlusion of the internal carotid artery (ICA). Aim. This study demonstrates locoregional anesthesias safety in patients with carotid cross clamping intolerance (CCI) and the risk factors that predict this condition. Materials and Methods. All patients who underwent surgical carotid endarterectomy between January 2019 and December 2020 (n=53, 29 were male, age (median with range) 78 (56-90) years) were identified in a retrospective review. The indication for surgical treatment was made for a stenosed ICA of 70-99% or in the case of symptomatic stenosis. Surgical technique. An incision is made at the front edge of the sternocleidomastoid muscle. The common carotid artery (CCA) is identified and isolated from the surrounding tissues with sharp dissection and continued toward the bifurcation. Next, the internal and external carotid arteries can be isolated. Heparin (5000 U) is administrated intravenously, and the systolic arterial pressure is increased and kept over 160 mm Hg. In the next step, the cross clamping tolerance test is performed for 60 s. During clamping, the patient is neurologically meticulously observed. In the case of CCI, the operation proceeds with the insertion of a temporary shunt. The arteriotomy is started in the CCA and continues to the ICA. The plaque is completely removed, and the arteriotomy incision is covered with a patch. Before completing the suture, the clamps are partially removed to flush out the debris using the blood flow. Now, the external and common artery can be released. Finally, the clamp of the ICA can be removed. Results. Eight patients had cross clamping tolerance test intolerance. In all these cases, the surgical procedure was continued with a shunt. The further operation course remained uncomplicated. The in-hospital mortality was nil, and a transient ischemic attack occurred in only one case. Coronary artery disease (CAD) [odds ratio (OR) 12.65, 95% confidence interval (CI) 1.43-112.50], a history of cerebrovascular events [OR 10.50, 95% CI 1.83-60.30], and contralateral stenosis of 70% or more [OR 26.66, 95% CI 2.29-304.37] presented a significant association with the CCI and the need to shunt. The remaining factors showed no significant association with intolerance. Conclusions. Regional anesthesia is a safe method for identifying patients with CCI and safely performing the surgical procedure. Contralateral stenosis of the ICA and a history of cerebrovascular events are significant factors to predict CCI.

V703: The Continent Extraperitoneal Vesico-Cutaneous Access Tunnel: A Novel Surgical Procedure for Managing Neurogenic Bladders

2006 ◽  
Vol 175 (4S) ◽  
pp. 227-227
Author(s):  
Ryan C. Hedgepeth ◽  
Michael Aleman ◽  
Humphrey Atiemo ◽  
Joseph Abdelmalak ◽  
Kubilay Inci ◽  
...  
Keyword(s):  
Surgical Procedure

Carotid Endarterectomy Can Improve Cognition

2010 ◽  
Vol 43 (19) ◽  
pp. 27
Author(s):  
LAIRD HARRISON
Keyword(s):  
Carotid Endarterectomy

Amputation in fictional literature: the case of Hippolyte in Madame Bovary

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 3-5 ◽  
Author(s):  
Kauss
Keyword(s):  
Surgical Procedure ◽  
Medical Profession ◽  
Major Amputation ◽  
Madame Bovary

In his famous novel, published in 1856, Flaubert describes the circumstances of a failed surgical procedure ending up in a major amputation. Flaubert, whose father was a physician in Rouen/France, mocks at the medical profession and its victims and proves himself to be compassionate at the same time. About his writing, he explained: "I only measure shit into doses." ("Je ne fais autre chose que de doser de la merde.")

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

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