Selective shunting with eversion carotid endarterectomy

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Presentation transcript:

Selective shunting with eversion carotid endarterectomy Enzo Ballotta, MD, Giuseppe Da Giau, MD Journal of Vascular Surgery Volume 38, Issue 5, Pages 1045-1050 (November 2003) DOI: 10.1016/S0741-5214(03)00605-0

Fig 1 Both a normal (A) and an elongated internal carotid artery (B) are transected at the bulb with an incision (broken line) almost longitudinal to the common carotid artery, taking a large patch and leaving a large hole in the common carotid artery. Journal of Vascular Surgery 2003 38, 1045-1050DOI: (10.1016/S0741-5214(03)00605-0)

Fig 2 A, First the shunt distal arm is pulled gently downward into the normal internal carotid artery lumen, passing beyond the end point. Then the proximal arm is inserted in the large hole of the common carotid artery. B, The eversion is then reduced, and the internal carotid artery is reanastomosed to the common carotid artery with a running “parachute” suture. C, Shunt is removed before completing the suture line, arteries are clamped briefly, and suture line is completed. Journal of Vascular Surgery 2003 38, 1045-1050DOI: (10.1016/S0741-5214(03)00605-0)

Fig 3 A, If the internal carotid artery (ICA) is redundant and a shunt is required, it is inserted in much the same way as in a nonredundant ICA, the only difference being that the proximal arm of the shunt is placed in the large new elliptic window in the common carotid artery (CCA; see text). The defect in the CCA is closed with a running over-and-over suture while the shunt is still inserted. B, The ICA is then reimplanted end-to-side on the lateral wall of the CCA. Journal of Vascular Surgery 2003 38, 1045-1050DOI: (10.1016/S0741-5214(03)00605-0)