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Prevention of Back Bleeding During Carotid Endarterectomy: Analysis of Clamping Techniques

Tamaki Tomonori1, Matano Fumihiro1, Yamazaki Michio1

  • 1Department of Neurological Surgery, Nippon Medical School, Tamanagayama Hospital, Tokyoto, Japan.

World Neurosurgery
|July 24, 2019
PubMed

Insights

Transient back bleeding during carotid endarterectomy (CEA) is uncommon. Severe carotid calcification and moderate stenosis increase risk, while vessel loops and crude clamps are superior to bulldog clamps for control.

Area of Science:

  • Vascular Surgery
  • Cerebrovascular Disease

Background:

  • Complete control of back bleeding during carotid endarterectomy (CEA) is crucial for patient safety.
  • Understanding the causes and effective management of back bleeding is essential for optimizing CEA outcomes.

Purpose of the Study:

  • To investigate the causes of back bleeding during CEA.
  • To evaluate techniques for controlling back bleeding during CEA.

Main Methods:

  • Retrospective review of 214 CEA procedures.
  • Assessment of preoperative factors, clamping instruments (vessel loop, crude, bulldog clamps), carotid stenosis severity, and arterial calcification.
  • Univariate analysis to identify factors associated with incomplete back bleeding control.

Main Results:

  • Transient back bleeding occurred in 8.9% of CEA procedures.
  • Ascending pharyngeal artery was the most common source (9 cases), followed by common carotid (8 cases) and external carotid arteries (2 cases).
  • Risk factors for incomplete back bleeding control included moderate carotid artery stenosis and the use of bulldog clamps.

Conclusions:

  • Transient back bleeding during CEA is infrequent.
  • Severe carotid calcification and moderate carotid stenosis are significant risk factors.
  • Vessel loops and crude clamps demonstrated superiority over bulldog clamps for effective carotid artery clamping.
Abstract

Keywords:
AtherosclerosisCarotid endarterectomyCommon carotid artery

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