carotid endarterectomy with Dacron patch angioplasty

PREOPERATIVE DIAGNOSIS: 

Right carotid stenosis.

POSTOPERATIVE DIAGNOSIS: 

Right carotid stenosis.

OPERATION:

Right carotid endarterectomy with Dacron patch angioplasty.

SURGEON:  

ASSISTANTS:  

ANESTHESIA:  General block.

COMPLICATIONS:  None.

DRAINS:  None.

SPECIMENS REMOVED:  Carotid plaque.

ESTIMATED BLOOD LOSS:  Minimal.

DESCRIPTION OF PROCEDURE/FINDINGS: 

After the induction of region anesthesia, the right neck was prepped and draped in the normal sterile fashion.

An incision was made anterior to the medial border of the sternocleidomastoid.  The skin and subcutaneous tissue was entered.  The medial border of the sternocleidomastoid was dissected out and this muscle was retracted laterally.  The internal jugular vein was identified and the medial border of this vein was dissected out.  The tributaries to this vein were taken between snaps and ligated with 2-0 and 3-0 silk ties.

The common carotid artery was identified and dissected out and controlled with vessel loops.  Dissection was carried out distally until the internal and external carotid arteries, as well as, the superior thyroid artery.  The hypoglossal ad vagus nerves were seen and preserved throughout the procedure.  The patient was systemically heparinized with 5,000 units of intravenous heparin.  Clamps were placed on the internal, external, and common carotid arteries.  The patient remained neurologically intact.

An arteriotomy was made in the common carotid artery extending into the internal carotid artery.  Endarterectomy was performed with adequate proximal and distal end points.  A Dacron patch was used to close the arteriotomy.  Prior to the closure of the arteriotomy, antegrade and retrograde flushing maneuvers were performed.  Patch closure was completed.

Clamps were removed.  There was a palpable pulse in the internal carotid artery and adequate Doppler signal.  The wound was irrigated with antibiotic solution and closed in layers.  The patient remained neurologically intact throughout the procedure.