Michiel H. F. Poorthuis, BSc, BA, Eelco C. Brand, BSc, Raechel J

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Presentation transcript:

Posterior transverse plication of the internal carotid artery to correct for kinking Michiel H.F. Poorthuis, BSc, BA, Eelco C. Brand, BSc, Raechel J. Toorop, MD, PhD, Frans L. Moll, MD, PhD, Gert Jan de Borst, MD, PhD Journal of Vascular Surgery Volume 59, Issue 4, Pages 968-977 (April 2014) DOI: 10.1016/j.jvs.2013.10.053 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Different types of elongation. A, Kinking; B, coiling; C, tortuosity. Journal of Vascular Surgery 2014 59, 968-977DOI: (10.1016/j.jvs.2013.10.053) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Angiogram reveals severe elongation of the stenotic internal carotid artery (ICA). Journal of Vascular Surgery 2014 59, 968-977DOI: (10.1016/j.jvs.2013.10.053) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Posterior transverse plication (PTP) as an additional shortening procedure following carotid endarterectomy (CEA). A, Kinked interal carotid artery (ICA). B, Length arteriotomy to perform the endarterectomy. C, Sutures are placed in longitudinal direction at the edges of the arteriotomy to create a posterior pouch, which is closed by continuous sutures that are tied outside of the ICA. D, The lateral remainders are closed. E, Arteriotomy is closed with a patch. F, The result of the PTP shortening of the ICA, creating a straightened ICA. Journal of Vascular Surgery 2014 59, 968-977DOI: (10.1016/j.jvs.2013.10.053) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Magnetic resonance angiogram (MRA) of the same patient as illustration A, after the posterior transverse plication (PTP) procedure. The desobstructed area and side of PTP can be recognized as a broader part of the straigthened internal carotid artery (ICA) distal to the bifurcation. Journal of Vascular Surgery 2014 59, 968-977DOI: (10.1016/j.jvs.2013.10.053) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 A, Resection of a portion of the internal carotid artery (ICA) and end-to-end anastomosis from the ICA onto the ICA. B, Resection of a portion of the ICA and end-to-end anastomosis from the ICA onto his origin on the bifurcation. C, Resection of a portion of the common cartotid artery (CCA) and end-to-end anastomosis from the CCA onto the CCA. D, The external carotid artery (ECA) is sacrificed after resection of a portion of the CCA and end-to-end anastomosis from the CCA onto the CCA. E, After end-to-end anastomosis from the CCA onto the CCA following resection of a portion of the CCA, a part of the ECA is replaced by an interposition graft. F, End-to-side anastomosis without resection of the ICA onto the CCA more proximally than the bifurcation. G, Reconstruction with an end-to-side anastomosis onto the ECA in patients with removal of a substantial segment of the ICA, so that the ICA is too short for anastomosing on to the bifurcation. H, Resection of the kinked part of the ICA followed by interposition grafting. Journal of Vascular Surgery 2014 59, 968-977DOI: (10.1016/j.jvs.2013.10.053) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 A, A slip of the sternocleidomastoid muscle can be inserted beneath the internal carotid artery (ICA). B, Anteposition of the ICA can also be performed by positioning the digastric muscle posterior of the ICA to keep the vessel fixed in the desired position. Journal of Vascular Surgery 2014 59, 968-977DOI: (10.1016/j.jvs.2013.10.053) Copyright © 2014 Society for Vascular Surgery Terms and Conditions