Abstract
A new eversion endarterectomy technique was used in 65 internal carotid artery reconstructions in 56 patients. The original features of the technique include a complete oblique transection of the internal carotid artery distal to the lesion and eversion endarterectomy through a longitudinal incision of the common carotid and external carotid arteries. The mean age of the patients was 68.2±7.8 years. Seventy-three percent of the patients had hypertension and 45.5% had coronary heart disease. Fifty-four percent experienced neurologic symptoms (transient in 36%, reversible in 6%, and permanent in 11%). Operations were performed under general anesthesia. An indwelling shunt was inserted whenever routine stump pressure was <50 mm Hg. There were no neurologic complications but one patient died of a compression hematoma of the neck, for a combined mortality and morbidity rate of 1.5%. Arteriograms were obtained from all patients on day 5 and showed complete restoration of normal anatomy in all cases and thrombosis of the external carotid artery in one. During a mean follow-up of 27 ± 4.7 months no strokes were observed. Follow-up duplex scans showed no hemodynamically significant restenoses. Eversion endarterectomy is a reliable alternative to other reconstruction procedures of the internal carotid artery.
Similar content being viewed by others
References
Scharcz TH, Yates GN, Ghobrial M, et al. Pathologic characteristics of recurrent carotid artery stenosis. J Vasc Surg 1987;5:280–288.
Zollikofer CL, Salomonovitz E, Sibley R, et al. Transluminal angioplasty evaluated by electron microscopy. Radiology 1984;153:372–374.
Thompson JE, Patman RD, Talkington CM. Asymptomatic carotid bruits: Long term outcome of patients having endarterectomy compared with unoperated controls. Ann Surg 1978;188:308–316.
Baker WH, Hayers AC, Mahler D, et al. Durability of carotid endarterectomy. Surgery 1983;94:112–115.
Kremen JE, Gee W, Kaupp HA, et al. Restenosis or occlusion after carotid endarterectomy: A survey with ocular plethysmography. Arch Surg 1979;114:608–610.
Callow AD, O'Donnel TF. Recurrent carotid stenosis: Frequency, clinical implications and some suggestions concerning etiology. In Bergan JJ, Yao JST, eds. Reoperative Arterial Surgery. New York: Grune & Stratton, 1986, pp 513–535.
Sundt TM, Houser OW, Whisnant JP, et al. Correlation of post-operative and two-year follow-up angiography with neurological function in 99 carotid endarterectomies in 86 consecutive patients. Ann Surg 1986;203:90–100.
Pierce GE, Illiopoulos JI, Holcomb MA, et al. Incidence of recurrent stenosis after carotid endarterectomy determined by digital subtraction angiography. Am J Surg 1984;148:848–854.
Eikelboom BC, Ackerstaff RG, Hoeneveld H, et al. Benefits of carotid patching: A randomized study. J Vasc Surg 1988;7:240–247.
De Vleeschauwer P, Wirthle W, Holler L, et al. Is venous patch grafting after carotid endarterectomy able to reduce the rate of restenosis? Prospective randomized pilot study with stratification. Acta Chir Belg 1987;7:242–246.
Archie JP. Prevention of early restenosis and thrombosis occlusion after carotid endarterectomy by saphenous vein patch angioplasty. Stroke 1986;17:901–905.
Keagy BA, Edrigton RD, Poolz MA, et al. Incidence of recurrent or residual stenosis after carotid endarterectomy. Am J Surg 1985;149:722–725.
Cormier JM, Chapelier A. Greffe veineuse carotidienne. In Kieffer E, Natali J, eds. Aspects Techniques de la Chirurgie Carotidienne. Paris: AERCV, 1987, pp 183–198.
Etheredge SN. A simple technique of carotid endarterectomy. Am J Surg 1970;120:275–278.
Jones CE. Carotid eversion endarterectomy revisited. Am J Surg 1989;157:323–328.
Berguer R. Eversion endarterectomy of the carotid bifurcation. In Veith FJ, ed. Current Critical Problems in Vascular Surgery, Vol. 5. St. Louis: Quality Medical Publishing, 1993, pp 441–447.
Kieny R, Hirsh D, Seiller C, et al. Does carotid eversion endarterectomy and reimplantation reduce the risk of stenosis? Ann Vasc Surg 1993;7:407–413.
Kline RA, Berguer R. Artéres carotides. In Kieffer E, ed. Le remplacement Artériel: Principes et Applications. Paris: AERCV, 1992, pp 367–375.
Hafner CC. Minimizing the risks of carotid endarterectomy. J Vasc Surg 1984;1:392–397.
Diley RB, Bernstein EF. A comparison of B-mode real-time imaging and arteriography in the intraoperative assessment of carotid endarterectomy. J Vasc Surg 1986;4:457–463.
Flanigan DP. Echographie per-opératoire en chirurgie carotidienne. In Kieffer E, Natali J, eds. Aspects Techniques de la Chirurgie Carotidienne. Paris: AERCV, 1987, pp 79–84.
Courbier R, Jausseran JM, Reggi M, et al. Routine intraoperative carotid angiography: Its impact on operative morbidity and carotid restenosis. J Vasc Surg 1986;3:343–349.
Thomas M, Otis SM, Rush M, et al. Recurrent carotid artery stenosis following endarterectomy. Ann Surg 1984;200:74–79.
Ennix CL, Lawrie GM, Morris GC, et al. Improved results of carotid endarterectomy in patients with symptomatic coronary disease. Stroke 1979;10:122–125.
Jernigan WR, Fulton RL, Hamman JL, et al. The efficacy of routine completion operative angiography in reducing the incidence of perioperative stroke associated with carotid endarterectomy. Surgery 1984;96:831–838.
Hunter GC, Palmaz JC, Hayashi HH, et al. The etiology of symptoms in patients with recurrent carotid stenosis. Arch Surg 1987;122:311–315.
L'AURC, Becquemin JP, Souadka F, et al. Risque opératoire actuel de la chirurgie carotidienne: Expérience du groupe vasculaire de L'AURC. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 41–50.
Hertzer ND, Martinez BD, Benjamin SP, et al. Recurrent stenosis after carotid endarterectomy. Surg Gynecol Obstet 1979;149:360–364.
Sundt TM, Piepgras DG, Ebersold MJ. Risk factors and operative results. In Sundt TM, ed. Occlusive Cerebrovascular Disease: Diagnosis and Surgical Management. Philadelphia: WB Saunders, 1987, pp 226–231.
Author information
Authors and Affiliations
About this article
Cite this article
Reigner, B., Reveilleau, P., Gayral, M. et al. Eversion endarterectomy of the internal carotid artery: Midterm results of a new technique. Annals of Vascular Surgery 9, 241–246 (1995). https://doi.org/10.1007/BF02135282
Issue Date:
DOI: https://doi.org/10.1007/BF02135282