By Christopher M. Loftus
Neurovascular techniques signify a huge point of a surgeon's perform. the new beneficial result of medical trials on carotid endarterectomy for stroke prevention have ended in a transforming into call for for surgeons who practice this process. Surgeons might be ready to satisfy the call for by means of studying the elemental rules, diagnositc standards and operative procedure for carotid endarterectomy. Dr Loftus stocks his perception and huge event during this clinically-oriented quantity. a number of radiographic examples illustrate the subtleties of picking the diseased artery, in addition to anatomic diversifications that make prognosis and surgical procedure much more tough. The method is illustrated with attractive line drawings observed by way of color images, and the textual content all through is an easy-reading, concise narrative. beneficial properties: * contains a particular part at the uncomplicated ideas underlying carotid endarterectomy * includes a part committed exclusively to diagnostic concerns with a variety of radiographic reviews illustrating universal and anomalous anatomy * comprises hundreds of thousands of pictures and drawings demonstrating all points of the technique
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Additional info for Carotid Endarterectomy: Principles and Technique
The importance of the use of blunt retractors to prevent vascular injury at this point cannot be overemphasized. Several small veins and one large common facial vein are customarily crossing the field and need to be doubly ligated and divided. The underlying carotid artery is soon identified once the jugular is retracted. It is typical to come upon the CCA first, and at the point of first visualization, the anesthesiologist is instructed to administer 5000 units of intravenous heparin, which is not reversed for the remainder of the procedure.
Monitoring Techniques In the ongoing attempt to reduce morbidity and mortality in carotid artery surgery under general anesthesia, a variety of intraoperative monitoring techniques have been developed to assess the need for increased cerebral protection, whether by induced hypertension or by intraluminal shunting. These techniques fall into two broad categories: (1) tests of vascular integrity such as stump pressure measurements, xenon rCBF studies, transcranial Doppler (TCD) monitoring and, to a lesser extent, intraoperative ocular pneumoplethysmography, Doppler!
A No. 11 blade is then used to begin the arteriotomy in the CCA, and when the lumen is identified, a Potts scissors is used to cut straight up along the marked line into the region of the bifurcation and then up into the ICA until the normal ICA is entered. The incision should extend up the midline of the vessel; lateral deviation increases the difficulty of hemostatic arterial repair. In severely stenotic vessels with friable plaques, the lumen is not always easily discerned and false planes within the lesion are often encountered.
Carotid Endarterectomy: Principles and Technique by Christopher M. Loftus