scholarly journals Mini skin incision for carotid endarterectomy (CEA): A new and safe alternative to the standard approach

2005 ◽  
Vol 42 (6) ◽  
pp. 1089-1093 ◽  
Author(s):  
Enrico Ascher ◽  
Anil Hingorani ◽  
Natalie Marks ◽  
Richard W. Schutzer ◽  
Manikyam Mutyala ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Skin Incision ◽  
Standard Approach ◽  
Safe Alternative

scholarly journals Analysis of twisted internal carotid arteries in carotid endarterectomy

2020 ◽  
Vol 11 ◽  
pp. 147
Author(s):  
Masaru Honda ◽  
Hajime Maeda
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Preoperative Evaluation ◽  
Twist Angle ◽  
Head Rotation ◽  
Skin Incision ◽  
External Carotid Artery ◽  
External Carotid ◽  
Position Correction

Background: The twisted carotid artery is a variant, in which the internal carotid artery (ICA) courses medially to the external carotid artery. Due to the sparse descriptions in the literature, we, here, report our experience with cases of carotid endarterectomy (CEA) for twisted carotid artery and its clinical features. Methods: Fifty-seven consecutive CEA-treated patients were evaluated, and the twist angle was measured on the source images of axial slices of computed tomography angiography (CTA). Results: Eight male patients (14.2%) demonstrated a twisted right ICA (mean age, 77.0 ± 2.6 years; and mean stenosis, 66.9% ± 19.9%). The mean twist angle was 30.1° ± 17.9°, while the normal ICA is angled at −23.0° ± 12.3°. No statistical differences in the distribution of coexisting diseases were found between the normal and twisted ICA cases. CEA was successfully performed with the correction of the carotid position in all cases; however, significant position correction was not observed in the postoperative evaluation. Right-side dominancy (P = 0.045) and prolonged clamping time (P = 0.053) were observed in the twisted cases. Conclusion: Twisted ICA was preferentially found in the right ICA and men. CEA of the twisted ICA was safely performed with appropriate head rotation and wider longitudinal skin incision than usual without a significant increase in the operative time. CTA is useful for preoperative evaluation. This specific variation should be considered by the neurosurgeon involved in the evaluation and treatment of carotid stenoses.

Mini-Skin Incision for Carotid Endarterectomy: Neurological Morbidity and Health-related Quality of Life

2020 ◽  
Author(s):  
Gianmarco de Donato ◽  
Edoardo Pasqui ◽  
Claudia Panzano ◽  
Massimiliano Walter Guerrieri ◽  
Domenico Benevento ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Carotid Endarterectomy ◽  
Skin Incision ◽  
Health Related Quality ◽  
Neurological Morbidity ◽  
Related Quality ◽  
Health Related

Comparison of cosmetic ef­fects after short longitudinal and transverse skin incision for carotid endarterectomy

2019 ◽  
Vol 82/115 (2) ◽  
pp. 194-202
Author(s):  
Tomáš Hrbáč ◽  
David Školoudík ◽  
David Otáhal ◽  
Táňa Fadrná ◽  
Roman Herzig
Keyword(s):  
Carotid Endarterectomy ◽  
Skin Incision ◽  
Transverse Skin Incision

Transverse Small Skin Incision for Carotid Endarterectomy

2015 ◽  
Vol 29 (3) ◽  
pp. 447-456 ◽  
Author(s):  
Terézia B. Andrási ◽  
Christof Kindler ◽  
Elke Dorner ◽  
Justus Strauch
Keyword(s):  
Carotid Endarterectomy ◽  
Skin Incision

scholarly journals PC114. Mini-Skin Incision for Carotid Endarterectomy: Neurologic Morbidity and Health-Related Quality of Life

2015 ◽  
Vol 61 (6) ◽  
pp. 148S
Author(s):  
Gianmarco de Donato ◽  
Francesco Setacci ◽  
Domenico Benevento ◽  
Maria Pia Borrelli ◽  
Giuseppe Galzerano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Carotid Endarterectomy ◽  
Skin Incision ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Intraoperative Stenting for Brachiocephalic and Carotid Artery Stenosis

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 876-882 ◽  
Author(s):  
Ichiro Nakahara ◽  
Toshio Higashi ◽  
Yasushi Iwamuro ◽  
Yoshihiko Watanabe ◽  
Hideaki Nakagaki ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Innominate Artery ◽  
Aortic Disease ◽  
Skin Incision ◽  
Artery Stenosis ◽  
Surgical Approaches ◽  
Distal Protection ◽  
Ischemic Attack

Abstract OBJECTIVE Endovascular stenting is an alternative treatment for brachiocephalic artery stenosis, replacing standard surgical approaches such as carotid endarterectomy. However, a percutaneous approach may be difficult because various conditions such as severe arteriosclerosis of iliac or femoral arteries and aortic disease. We report our experience with intraoperative stenting for these lesions, presenting indications, strategy, and results. METHODS Seven patients underwent intraoperative stent placement via an open cervical approach. The sites of lesions included 1 innominate artery, 1 common carotid artery, and 5 cervical carotid arteries. Stenting was performed with a sheath introducer placed through a surgically exposed common carotid artery via a small skin incision or common carotid artery exposed for simultaneously performed carotid endarterectomy. Distal protection was used in 6 patients with an endovascular protective balloon or external clamping with forceps. RESULTS Sufficient dilation of stenosis was obtained in all cases. No complications such as transient ischemic attack, cerebral infarction, and hyperperfusion were encountered. Wound hematoma was not experienced despite perioperative antiplatelet therapy and heparinization during the procedure. Angiographic follow-up over 1 year showed no restenosis in 5 available patients. CONCLUSION Intraoperative stenting may be an excellent alternative for patients in whom both direct surgical approach and standard percutaneous endovascular approach are not possible.

Mini-Bentall: An Interesting Approach for Selected Patients

2017 ◽  
Vol 12 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Elisa Mikus ◽  
Antonio Micari ◽  
Simone Calvi ◽  
Maria Salomone ◽  
Marco Panzavolta ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Elective Surgery ◽  
Skin Incision ◽  
Ascending Aorta ◽  
Minimally Invasive Approach ◽  
Safe Alternative ◽  
Invasive Approach

Objective Minimally invasive surgery through an upper hemisternotomy for aortic valve replacement has become the routine approach with excellent results. Actually, the same minimally invasive access is used for complex ascending aorta procedures only in few centers. We report our experience with minimally invasive approach for aortic valve and ascending aorta replacement using Bentall technique. Methods From January 2010 to November 2015, a total of 238 patients received ascending aorta and aortic valve replacement using Bentall De Bono procedure at our institution. Low- and intermediate-risk patients underwent elective surgery with a minimally invasive approach. The “J”-shaped partial upper sternotomy was performed through a 6-cm skin incision from the notch to the third right intercostal space. Patients who had previous cardiac surgery or affected by active endocarditis were excluded. The study included 53 patients, 44 male (83 %) with a median age of 63 years [interquartile range (IQR), 51–73 years]. A bicuspid aortic valve was diagnosed in 27 patients (51%). Results A biological Bentall using a pericardial Mitroflow or Crown bioprosthesis implanted in a Valsalva graft was performed in 49 patents. The remaining four patients were treated with a traditional mechanical conduit. Median cardiopulmonary bypass time and median cross-clamp time were respectively 84 (IQR, 75–103) minutes and 73 (IQR, 64–89) minutes. Hospital mortality was zero as well as 30-day mortality. Median intensive care unit and hospital stay were 1.9 and 8 days, respectively. The study population compared with patients treated with standard full sternotomy and similar preoperative characteristics showed similar results in terms of postoperative outcomes with a slightly superiority of minimally invasive group mainly regarding operative times, incidence of atrial fibrillation, and postoperative ventilation times. Conclusions A partial upper sternotomy is considered a safe option for aortic valve replacement. Our experience confirms that a minimally invasive approach using a partial upper J-shaped sternotomy can be a safe alternative approach to the standard in selected patients presenting with complex aortic root pathology.

scholarly journals Haematomas after carotid endarterectomy can be reduced by direct pressure to the neck postoperatively

2018 ◽  
Vol 100 (7) ◽  
pp. 580-583 ◽  
Author(s):  
R Saghir ◽  
G Humm ◽  
T Rix
Keyword(s):  
Carotid Endarterectomy ◽  
Intervention Group ◽  
Skin Incision ◽  
Maximum Effect ◽  
Post Intervention ◽  
Direct Pressure ◽  
Excessive Strain ◽  
Postoperative Haematoma ◽  
The Impact ◽  
Post Intervention Group

Introduction A recognised complication of carotid endarterectomy (CEA) is postoperative haematoma, which can threaten the airway. Previous studies have looked at medical methods of preventing this complication. This study aims to evaluate the impact of simple direct pressure postoperatively on the development of haematoma. Materials and methods From 2011 to 2016, 161 consecutive CEA were performed by a single surgeon or trainee under supervision. After 80 operations, the postoperative technique was altered, with additional pressure being applied by the surgeon to the skin incision from completion of suturing until each patient was awake in the recovery room. The rates of postoperative haematoma and other complications were compared between the pre- and post-intervention groups, as well as grade of surgeon, urgency of operation and antiplatelet/anticoagulant use. Results Post-carotid haematomas were eliminated in the post-intervention group (0/81); in the pre-intervention group 7/80 patients developed haematoma (P < 0.05). There were no significant differences in urgency of surgery, antiplatelet/anticoagulant use, grade of surgeon or other complications (stroke: 2/80 vs 0/81 P < 0.05), suggesting that this was not a learning curve effect. Discussion The results suggest that applying direct pressure helps to reduce oozing, provides time to monitor and identify additional bleeding and protects the wound from excessive strain that may be caused by coughing while the patient wakes up. We advise that the lead surgeon should apply such pressure to ensure precise and focal targeting, for maximum effect. Conclusion During recovery from CEA, focused and prolonged pressure by the operating surgeon is a highly effective method of reducing haematoma.

Carotid Endarterectomy

Neurosurgery ◽  
2014 ◽  
Vol 75 (2) ◽  
pp. 110-116 ◽  
Author(s):  
George A. C. Mendes ◽  
Joseph M. Zabramski ◽  
Ali M. Elhadi ◽  
M. Yashar S. Kalani ◽  
Mark C. Preul ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Nerve Injury ◽  
Neurological Complication ◽  
Skin Incision ◽  
Nerve Injuries ◽  
Transverse Incision ◽  
Longitudinal Incision ◽  
Marginal Mandibular Nerve ◽  
Increased Risk ◽  
Transverse Skin Incision

Abstract BACKGROUND: Cranial nerve injury (CNI) is the most common neurological complication associated with carotid endarterectomy (CEA). Some authors postulate that the transverse skin incision leads to increased risk of CNI. OBJECTIVE: We compared the incidence of CNI associated with the transverse and longitudinal skin incisions in a high-volume cerebrovascular center. METHODS: We reviewed the charts of 226 consecutive patients who underwent CEAs between January 2007 and August 2009. Pre- and postoperative standardized neurological evaluations were performed by faculty neurologists and neurosurgeons. RESULTS: One hundred sixty nine of 226 (75%) CEAs were performed with the use of a transverse incision. The longitudinal incision was generally reserved for patients with a high-riding carotid bifurcation. Mean patient age was 69 years (range, 45–91 years); 62% were men; 59% of patients were symptomatic and had high-grade stenosis (70%-99%). CNI occurred in 8 cases (3.5%): 5 (3%) in transverse and 3 (5.3%) with longitudinal incisions (P = .42). There were 2 marginal mandibular nerve injuries, 1 (0.6%) transverse and 1 longitudinal; 5 recurrent laryngeal nerve injuries, 4 transverse and 1 longitudinal; and 1 case of hypoglossal nerve injury associated with longitudinal incision. One hematoma was associated with CNI. All injuries were transient. Fourteen wound hematomas required surgical evacuation. CONCLUSION: The transverse skin incision for CEAs is not associated with an increased risk of CNI (P =.42). In this study, the incidence of CNI associated with the transverse incision was 3% (n = 5) vs 5% (n = 3) for longitudinal incisions. All CNIs were temporary.

Comparison of short longitudinal and transverse skin incision for carotid endarterectomy

2017 ◽  
Vol 381 ◽  
pp. 517
Author(s):  
T. Hrbac ◽  
D. Skoloudik ◽  
D. Otahal ◽  
T. Fadrna ◽  
Z. Vecera
Keyword(s):  
Carotid Endarterectomy ◽  
Skin Incision ◽  
Transverse Skin Incision
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