Vascular endoscopy --- an adjunct to carotid surgery.

TLDR

Technical advances in optical instrumentation have made vascular endoscopy a potential method for intraoperative evaluation of carotid endarterectomy. A prospective protocol was designed to evaluate the efficacy and practicality of this technique using the Hopkins Optical System in 35 carotid endarterectomies. The external carotid artery was examined after completion of the endarterectomy, and the distal internal carotid artery was examined after shunt removal with the arteriotomy closed except for 1 cm. The procedure took less than 5 minutes in 21 cases and 5–10 minutes in 14, with positive findings in 71 % of external carotid endarterectomies (intimal flaps in 13 cases and intimal shreds in 25) and intimal shreds in 2 patients (6 %) of internal carotid endoscopy that could embolize, demonstrating that the technique allows precise and complete evaluation of the vascular reconstruction.

Abstract

Technical advances in optical instrumentation have made vascular endoscopy a potential method for intraoperative evaluation of carotid endarterectomy. A prospective protocol was designed to evaluate the efficacy and practicality of this technique using the Hopkins Optical System in 35 carotid endarterectomies. The external carotid artery was examined after completion of the endarterectomy. The distal internal carotid artery was examined after removal of the shunt with all but 1 cm of the arteriotomy closed. Total time required for the procedure was less than 5 minutes in 21 cases and between 5 and 10 minutes in 14. Positive findings were noted in 71% of the external carotid endarterectomies which consisted of intimal flaps in 13 cases and intimal shreds in 25. In 2 patients (6%), internal carotid endoscopy revealed intimal shreds capable of embolizing and probably capable of causing a postoperative neurologic deficit. This technique permits a precise and complete evaluation of the vascular reconstruction.