[Certain technical aspects of performing carotid endarterectomy].
The study was aimed at improving the results of carotid endarterectomy (CEA) by means of improving technical methods of performing reconstruction of the carotid bifurcation. From January 2012 to December 2014 at the Department of Vascular Surgery we performed a total of 703 CEA operations, including 183 (26%) according to the classical technique and 520 (74%) according to the eversion technique. The average age of patients amounted to 61.8±9.5 years. Operations were performed in patients with more than 70% stenoses of the internal carotid artery (ICA). 673 reconstructions were performed under general anaesthesia and 30 under the regional one. The preoperative examination included ultrasound duplex scanning (USDS), transcranial dopplerography, transcranial duplex scanning, magnetic resonance tomography (angiography). The technical result of the operation was assessed by means of intraoperative USDS. 62 (9%) patients underwent eversion CEA with prolongation of the cut on the ICA and external carotid artery (ECA) with the formation of an "extended" anastomosis between them. 28 (4%) patients were subjected to the classical CEA with the use of the technique of formation of a new bifurcation of the carotid artery by means of Y-shaped arteriotomy of the common carotid artery, ICA and ECA. In order to prevent flotation of the proximal portion of the atherosclerotic plaque cut in the common carotid artery it was fixed by II-shaped sutures. The remote results of eversion CEA with the creation of the "extended" anastomosis were followed up in 42 (68%) patients within the terms of 21±8 months. There were neither lethal outcomes nor strokes. Significant stenosis (more than 70% of the ICA lumen) was revealed in one patient. After CEA with the formation of a new bifurcation in the immediate postoperative period there were no cerebral circulation impairments. 18 (64%) patients were examined in the remote terms (21±9 months). There were neither lethal outcomes nor strokes. The check USDS revealed no significant restenoses of carotid arteries. Conclusion were drawn that preliminary marking of the carotid bifurcation with the help of USDS made it possible to optimize the length of the approach during CEA. The routine application of intraoperative USDS gives a possibility to reveal floating portions of the intima, thrombotic masses and to timely take measures aimed at removing these defects. The method of forming a new bifurcation of the carotid artery may be used in prolonged stenotic lesions of carotid arteries. This makes it possible to avoid the use of a synthetic patch with possible unfavourable aftermaths, thus considerably shortening the duration of the main stage of reconstruction.