Surgical Techniques from Intraoperative Angiographic and Velocimetric Controls in 43 Consecutive Carotid Bifurcation Endarterectomies

From January to November, 1985, 43 carotid bifurcation endarterectomies (CE) were performed with intraoperative functional (Doppler spectrum analy sis) and morphologic (angiography) controls. In the first 20 cases, after thromboendarterectomy and direct suture, Dop pler showed absence of or no significant variations of frequency in 17 cases, a frequency increase corresponding to a less than 45% diameter reduction steno sis at the apex of the suture in 2 cases, and no flow in the internal carotid artery (ICA) in 1 case. Angiography confirmed the thrombosis in the above mentioned case and showed 3 less than 50% stenoses at the distal end of the arteriotomy: 2 already recognized by Doppler in small-size ICAs and 1 in a medium-size ICA without significant changes of flow. The reason for thrombosis was a distal intimal flap, which was successfully removed; the 2 stenoses in which Doppler and angiography agreed were corrected by patch angioplasty. In the last 23 cases, patch angioplasty was performed routinely in small-size ICAs (6 cases); in 1 case, first treated by a direct suture, Doppler and angiography showed a medium-grade stenosis, immediately corrected; in 1 case both techniques showed a 50% stenosis in a common carotid artery, immediately corrected. The execution of intraoperative angiography in this group of patients al lowed the authors to define the indication for the use of patch angioplasty, never previously employed. Nevertheless, the authors state that, on account of loss of time, costs, and exposure to radiations, intraoperative angiography must be reserved for those cases selected by Doppler spectrum analysis. This method seems to be highly sensitive in recognizing significant technical defects that could lead to an immediate or late failure.