Retrojugular approach for carotid endarterectomy: a prospective cohort study

The purpose of this study was the examination of the feasibility of the retrojugular approach for carotid endarterectomy and the investigation of its safety and effectiveness. A consecutive prospective cohort of 43 patients who underwent carotid endarterectomy with the retrojugular approach was compared with a retrospective cohort of 43 patients who underwent surgery with the standard antejugular technique. Age, sex, comorbidity, diagnostic investigations, and indications for surgery were comparable in both groups. In the retrojugular group, a carotid shunt was used in 18 patients (42%) and a patch closure in 15 patients (35%), and in the antejugular group, a carotid shunt was used in 43 patients (100%) and a patch closure in 20 patients (47%). There were no perioperative deaths, strokes, nerve injuries, or 30-day postoperative neurologic events. Wound hematomas were equally distributed in both groups (5%). Transient hoarseness was present in two patients in the antejugular group. The mean operative time was 72 +/- 15 minutes for the retrojugular technique and 100 +/- 27 for the antejugular technique (P <.0001). The hospital stay was 2 +/- 1 days in both groups. In conclusion, the retrojugular approach appears to be safe and the operative time may be shorter than with the antejugular approach.