Reducing the risk of carotid surgery: A 7-year audit of the role of monitoring and quality control assessment A.Ross Naylor, MDa, Paul D. Hayes, FRCSa,

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Reducing the risk of carotid surgery: A 7-year audit of the role of monitoring and quality control assessment A.Ross Naylor, MDa, Paul D. Hayes, FRCSa, Holger Allroggen, MRCPb, Nikki Lennard, FRCSa, Michael E. Gaunt, MDa, Matthew M. Thompson, MDa, Nicholas J.M. London, MDa, Peter R.F. Bell, MDa Journal of Vascular Surgery Volume 32, Issue 4, Pages 750-759 (October 2000) DOI: 10.1067/mva.2000.108007 Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Top left, Hysteroscope used during intraoperative angioscopy. Top right, Completion angioscopy study of endarterectomy zone and distal ICA shows possible plane of dissection under intima; this was corrected surgically. Bottom left, Mural thrombus adherent to endarterectomy zone, adjacent to proximal common carotid step. Bottom right, Thrombotic material retrieved from endarterectomy zone after angioscopy. Journal of Vascular Surgery 2000 32, 750-759DOI: (10.1067/mva.2000.108007) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Normal completion angioscopy. Journal of Vascular Surgery 2000 32, 750-759DOI: (10.1067/mva.2000.108007) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Bleeding vasa vasorum (arrow) that is source of luminal thrombus in endarterectomy zone. Journal of Vascular Surgery 2000 32, 750-759DOI: (10.1067/mva.2000.108007) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 A, Effect of dextran on embolus count in early postoperative period in patient who had postoperative embolic stroke on day 5 (case 10, Table III). Within 4 hours, embolization had ceased, and no neurologic deficit occurred. B, On day 5, patient had upper limb monoparesis and was found to be embolizing profusely. Dextran was again administered (50 mL/h), rate of embolization decreased rapidly, and patient made significant clinical recovery (OHS score of 1 at 30 days). Journal of Vascular Surgery 2000 32, 750-759DOI: (10.1067/mva.2000.108007) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions