World Journal of Surgery

, Volume 3, Issue 2, pp 167–175 | Cite as

Seventeen-year experience with routine shunting in carotid artery surgery

  • Hushang Javid
  • Ormand C. Julian
  • William S. Dye
  • James A. Hunter
  • Hassan Najafi
  • Marshall D. Goldin
  • Cyrus Serry
  • Giacomo A. DeLaria
World Progress in Surgery

Abstract

Safety of carotid artery surgery depends on proper case selection, meticulous surgical technique, and appropriate protection of the brain during carotid artery cross-clamping. Various methods have been devised to determine the adequacy of collateral circulation, none of which has been proven practical and totally reliable. Attempts at increasing cerebral perfusion to the ischemic portion of the brain by induced hypertension, hypercarbia, and hypocarbia have been ineffective.

The purpose of this presentation is to report our experience with routine intraluminal shunting in carotid artery surgery during the past 17 years. Advantages of routine shunting include maintenance of regional cerebral blood flow at the preclamping level and the elimination of any need for monitoring and haste during surgery. Insertion of the tube, properly done, does not injure the arterial wall and should not cause embolization. The presence of the tube within the arterial lumen does not interfere with exposure of the atheroma, yet it facilitates repair of the incision and prevents stricture by faulty suturing technique. Results of carotid artery surgery measured by the incidence of stroke are compared between shunted and nonshunted series. A review of the literature confirms our impression that shunting reverses ischemic changes detected by EEG and regional cerebral blood flow determinations. The usefulness of shunting in the surgical management of internal carotid aneurysm, kinked carotid artery, carotid body tumor, and carotid-subclavian bypass graft is also described.

Résumé

Dans la chirurgie carotidienne, le succès dépend de la sélection des cas, de l'attention aux détails de l'intervention, d'une protection adéquate du cerveau pendant le clampage de la carotide. Diverses méthodes ont été proposées pour vérifier, pendant le clampage, l'efficacité de la circulation collatérale. Elles sont peu pratiques et n'offrent pas toute garantie de sécurité. Les tentatives d'améliorer la perfusion cérébrale dans les zones cérébrales ischémiées, par hyper-et hypocapnie, se sont révelées inefficaces.

Le présent rapport décrit notre expérience d'utilisation de routine d'un shunt intracarotidien au cours des 17 dernières années. Ce type de shunt offre plusieurs avantages: il maintient un débit sanguin cérébral inchangé malgré le clampage; le monitoring cérébral devient inutile; l'opération peut être faite sans précipitation. Si le tube est bien mis en place, il ne lèse pas la paroi artérielle et ne doit pas détacher d'embols. La présence du tube dans la lumière artérielle ne gène pas la mise en évidence des lésions d'athéromatose; elle facilite la suture artérielle et évite les erreurs de technique qui pourraient être responsables de sténoses. Nous avons comparé les résultats de la chirurgie carotidienne dans des séries de malades opérés avec et sans shunt interne. Une revue de la littérature confirme notre impression: le shunt ramène à la normale l'EEG et le débit sanguin cérébral. Le shunt est également utile pour la chirurgie des anévrismes de la carotide interne, des coudures de ce vaisseau, des tumeurs du sinus carotidien et des bypass carotido-sous-claviers.

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Copyright information

© Société Internationale de Chirurgie 1979

Authors and Affiliations

  • Hushang Javid
    • 1
  • Ormand C. Julian
    • 1
  • William S. Dye
    • 1
  • James A. Hunter
    • 1
  • Hassan Najafi
    • 1
  • Marshall D. Goldin
    • 1
  • Cyrus Serry
    • 1
  • Giacomo A. DeLaria
    • 1
  1. 1.Department of Cardiovascular-Thoracic SurgeryRush-Presbyterian-St. Luke's Medical CenterChicagoUSA

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