Reese A. Wain, MD, Ross T. Lyon, MD, Frank J. Veith, MD, George L

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Presentation transcript:

Accuracy of duplex ultrasound in evaluating carotid artery anatomy before endarterectomy Reese A. Wain, MD, Ross T. Lyon, MD, Frank J. Veith, MD, George L. Berdejo, BA, RVT, John G. Yuan, MD, William D. Suggs, MD, Takao Ohki, MD, Luis A. Sanchez, MD Journal of Vascular Surgery Volume 27, Issue 2, Pages 235-244 (February 1998) DOI: 10.1016/S0741-5214(98)70354-4 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Location of the carotid bifurcation. A, Angle of mandible is at the level of intersection of straight lines drawn along posterior border of mandibular ramus (a) and inferior border of mandibular body (b). Carotid bifurcation is at the level of the flow divider between internal and external carotid arteries (c). Distance from carotid bifurcation to mandible is measured between these two levels. B, Intraoperative view of distance measured from carotid bifurcation to sternal notch (a) and angle of mandible (b). Journal of Vascular Surgery 1998 27, 235-244DOI: (10.1016/S0741-5214(98)70354-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Distal extent of plaque. A, Distal extent of plaque is measured between the level of the most distal plaque (a) and carotid bifurcation (b). B, Duplex study reveals focal lesion (arrows) that extends 1.8 cm from carotid bifurcation (top). Another study shows a longer lesion (arrows) that extends more than 2 cm from carotid bifurcation (bottom). Journal of Vascular Surgery 1998 27, 235-244DOI: (10.1016/S0741-5214(98)70354-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Internal carotid artery diameter. Diameter of internal carotid artery is measured distal to endpoint of plaque (inset). Journal of Vascular Surgery 1998 27, 235-244DOI: (10.1016/S0741-5214(98)70354-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Redundancy or kinking of internal carotid artery. A, Straight lines are drawn along central axis of internal carotid artery (ICA) proximal and distal to its most extreme angulation (dashed lines). Measured ICA angulation (curved arrow) is assessed at their site of intersection. Degree of ICA angulation is calculated by subtracting measured ICA angulation from 180 degrees. B, Duplex study reveals normal ICA with less than 30 degrees of angulation (left). In contrast, another duplex reveals redundant ICA with between 30 and 60 degrees of angulation (right). Journal of Vascular Surgery 1998 27, 235-244DOI: (10.1016/S0741-5214(98)70354-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Operative assessment of the distal extent of plaque. Carotid plaque has been removed as an en bloc “cast” of common carotid artery, internal carotid artery, and external carotid artery. Carotid bifurcation is denoted by tip of small arrow, and distal extent of internal carotid artery plaque is marked by tip of large arrow. Extent of disease is then measured between the two arrows. Journal of Vascular Surgery 1998 27, 235-244DOI: (10.1016/S0741-5214(98)70354-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions