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[Combined carotid endarterectomy and off-pump coronary artery bypass grafting]
E Suenaga1, K Rikitake, K Furukawa
1Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Japan.
Insights
Combined carotid endarterectomy and off-pump coronary artery bypass grafting (CABG) is a safe procedure for patients with severe carotid stenosis and angina. This combined approach led to successful recovery without neurological complications in a high-risk patient.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Vascular Surgery
Background:
- Patients with angina and severe carotid stenosis face high mortality risks.
- Combined surgical procedures require careful planning and execution.
Observation:
- A 74-year-old male patient with severe carotid stenosis underwent a combined carotid endarterectomy and off-pump coronary artery bypass grafting (CABG).
- Specialized instruments, including the Jamieson dissector and ultrasound dissector, were used for enhanced surgical precision.
- The internal mammary artery was skeletonized and used for anastomosis to the left anterior descending artery with an Octopus II stabilizer.
Findings:
- The combined procedure was performed successfully, with the patient recovering uneventfully.
- No neurological complications were observed post-operatively.
- The use of specialized dissectors facilitated simultaneous dissection and blood removal during carotid endarterectomy.
- Skeletonization of the internal mammary artery ensured a long graft with good blood flow while minimizing sternal damage.
Implications:
- Combined single-staged carotid endarterectomy and off-pump CABG represents a safe and effective treatment option for select high-risk patients.
- Minimally invasive techniques and specialized instruments can improve outcomes in complex cardiovascular and cerebrovascular surgeries.
- This approach may reduce the overall treatment burden and recovery time for patients requiring both procedures.
Abstract:
Patients with angina undergoing carotid endarterectomy have a high mortality. A 74-yaer-old man who has severe carotid stenosis was performed combined carotid endarterectomy and off-pump coronary artery bypass grafting successfully. At first, carotid endarterectomy was performed with Jamieson's specially designed dissector, which allow simultaneous dissection and removal blood from the surgical field. Secondly, then off-pump CABG was performed. Skeletonized internal mammary artery was harvested with ultrasound dissector. The advantage of that the dissected artery is not only long and greater blood flow, but also less damage to sternal blood flow which prevent infection and complications. Then internal mammary artery was anastomosed to left anterior discending artery with Octopus II stabilizer. After the operation, he recovered uneventfully without neurological complication. Combined single staged carotid endarterectomy and off-pump CABG appears to be a safe method.