How is CEA performed to treat atherosclerotic disease of the carotid artery?

Updated: Oct 04, 2018
  • Author: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

A vertical skin incision is made along the anterior border of the sternocleidomastoid. The dissection is carried down to the carotid sheath, which is opened longitudinally to expose the carotid arteries. (See the image below.)

Carotid artery exposed prior to carotid endarterec Carotid artery exposed prior to carotid endarterectomy (coil present in internal carotid artery).

The endarterectomy is carried out in a smooth plane in the media of the artery. The most important aspect of this portion of the procedure is to obtain a smooth, tapering endpoint on the internal carotid (see the image below). Occasionally, tacking sutures are required to accomplish this.

Carotid artery following endarterectomy and prior Carotid artery following endarterectomy and prior to closure (tapered endpoint and smooth appearance of lumen).

The endarterectomy is closed either primarily or with a patch (see the image below). The technical result should be verified by means of completion angiography or duplex ultrasonography (US).

Carotid artery following Dacron patch angioplasty. Carotid artery following Dacron patch angioplasty.

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