Personal experience in treatment of recurrent narrowing of internal carotid artery and occlusion of the external carotid artery

Abstract

Background. At the Department of Vascular, General and Transplant Surgery, 1087 procedures for restoring the patency of a stenosis of an internal carotid artery were carried out in the years 1996 to 2001.
Material and methods. 403 patients out of this group were operated on by the traditional method of endarterectomy secured by a plane suture and 306 by the eversion method. The ”Y”-arterioplasty technique was applied in 62 patients.
Results. During the 3-year follow-up period, recurrent stenosis of an internal carotid artery was observed in 42 patients and involved the external carotid artery in 12 patients. An endarterectomy was closed with a Dacron patch in 30 patients and an arterial partition reconstruction ”Y” surgery was performed on 12 patients. In all cases, the diagnosis was made upon a physical examination, coloured Doppler examination and angiography according to Seldinger’s method.
Conclusions. A ”Y”-incision allowed the precise endarterectomy, both of the partition and of the changed initial sections of the external and internal carotid arteries. The described ”Y”-arterioplasty of the partition of a common carotid artery complies with the requirements imposed on an endarterectomy of an internal carotid artery partition. Additionally, the shifting of a partition superiorly to the site of a restored patency may safeguard a patient against recurrent stenosis, according to our material, caused mainly by hypertrophic fibrous pathologic changes developing within the site of endarterectomy.