Endarterectomy

Transit-Time Flow Measurement Improves Endarterectomy Outcomes

Over 120,000 carotid endarterectomies are performed each year in the United States. The value of flow measurement in these procedures has been documented in several medical journals. A sterile tubing Flowsensor placed on a Javid or Pruitt/Inahara shunt safeguards brain perfusion during the procedure. Perivascular flow measurements at the conclusion of the procedure may identify low or turbulent flow caused by a correctable technical error.

CAROTID_ART1jpg No special adjustment in surgical technique is necessary for measurement of blood flow during carotid surgery. The sites on the carotid arteries skeletonized by dissection for vascular clamp placement are identical as those employed for probe placement. A 10 mm probe (sometimes an 8 mm probe is used) is employed for the distal common carotid artery and a 6 mm probe for the origin of the internal and external carotid arteries.

The probe on the external carotid is placed just distal to the origin of the superior thyroid artery. We perform the pre-endarterectomy flow measurements immediately after administration of systemic heparin, and the measurement of all three arteries only requires a few minutes.

After the first measurement, vascular clamps are placed and the endarterectomy performed. Placing a clamp-type probe on the shunt ensures that any interruption of shunt flow is detected.

After finishing the endarterectomy, removal of all clamps, and establishing hemostasis, a repeat flow measurement is performed. Occasionally, low flow or a turbulent flow waveform is detected indicating the presence of a significant stenosis which requires immediate revision. As a consequence, we try not to reverse heparin with protamine until completion of the flow measurements.

Caratid Endarterectomy Publications

Gordon, I.L., Stemmer, E.A., Wilson, S.E., "Redistribution of Blood Flow after Carotid Endarterectomy," Journal of Vascular Surgery, Vol. 22, p. 349-360, 1995. (593AH)

Gordon, I.L., Weil, J., Williams, R.A., Wilson, S.E. "Intraoperative Measurement of Javid Shunt Flow with Transit-Time Ultrasound," Annals of Vascular Surgery, 8(6) 571-577, 1994. (371AH)

Gordon, I.L., Stemmer, E.A., Williams, R.A., Arafi, M., Wilson, S.E. "Changes in Internal Carotid Blood Flow after Carotid Endarterectomy Correlate with Preoperative Stenosis," The American Journal of Surgery, Vol. 168, p. 27-130, 1994.(364AH)

Gordon, I.L., Goldstein, L.J., Ceraldi, C., Weir, P., Tobis, J., Stemmer, E., "Hemodynamic Effects of Serial Stenoses in An Arterial Model," American College of Surgeons, Surgical Forum, XLII, p. 315-319, 1991. (192AH)