Problem:
This 60-year-old woman recently underwent a screening carotid duplex scan, which suggested a significant right carotid stenosis. She was referred here for a formal vascular surgical consultation and repeat duplex scan at this institution, which confirmed a high-grade, 70%-99%, right internal carotid stenosis. In view of this significant right carotid lesion and a family history of stroke, as well as her otherwise apparent good medical risk, the patient elected to proceed at this time with right carotid endarterectomy. Operation: Right carotid endarterectomy and Hemashield Dacron patch angioplasty using intra-luminal shunt. Preoperative Diagnosis: Severe right internal carotid stenosis Postoperative Diagnosis: Same Procedure Description: With the patient in the supine position and the head extended and turned to the left, the right neck and chest regions were prepped and draped in the usual fashion. A longitudinal incision was made along the anterior border of the sternocleidomastoid muscle and deepened through the subcutaneous tissues and platysma. The sternocleidomastoid muscle was sharply dissected posteriorly. The internal jugular vein was identified, medial branches were ligated with 2-0 silk sutures and divided, and the internal jugular vein was mobilized posteriorly. Using sharp and blunt dissection, the common carotid artery was identified, it was sharply freed from its surrounding tissues, and controlled well proximal to the bifurcation with an umbilical tape. The dissection was carried distally and using sharp and blunt dissection, individual control was obtained of the internal carotid artery several centimeters beyond the bifurcation, where it appeared to be disease-free, and the external carotid artery just beyond bifurcation, with vessel loops. An unusual branch of the common carotid artery posteriorly was identified and controlled with a 2-0 silk suture. The hypoglossal nerve was identified at the apex of the incision and the vagus nerve deep to the artery, and both the nerves were carefully protected throughout the course of the procedure. There appeared to be a calcified plaque at the carotid bifurcation with extension into the proximal internal carotid artery. Need Assignment Help?