[Carotid endarterectomy with Javid bypass and supraorbital photoplethysmography]

Bypass patency was monitorized by photoplethismography of supraorbital artery during Javid's bypass clamping in the course of carotid endarterectomy in 12 patients. This technique allows a rapid and easy detection of partial or total bypass occlusion which is manifested by a reduction in the plethysmographic wave amplitude in the ipsilateral supraorbital artery with respect to data obtained before operation or with the plethysmographic curve recorded at the contralateral artery. Among the twelve patients only five (41.6%) showed no evidence of bypass malfunction. Two patients (16.6%) suffered one episode of bypass insufficiency, four (33.3%) patients presented three episodes and one patient (8.33%) complained four episodes of bypass dysfunction. None of bypass dysfunctions were detected by the surgical team. Bypass insufficiency was due to excessive traction that caused leaning of the vessel or to malposition of the end of the bypass. Both were promptly corrected. We conclude that besides implantation of the bypass it is worthwhile monitoring its function by recording the photoplethysmographic response of the supraorbital artery which, in turn, is a safe and easy technique.