The impact of completion arteriography on results and technique of carotid surgery

With the intent of minimizing the occurrence of technical defects, we adopted the routine use of completion arteriography for carotid surgery. Fifty-six procedures were performed. Postoperative TIAs occurred twice (3.6%). Technical deficits, judged to be unacceptable, were identified and corrected in eight cases. Six of the defects requiring repair occurred in the first 11 cases. Only two of the last 45 required revision. A single stroke occurred when an intimal flap was overlooked on an inadequate arteriogram. An intimal laceration attributable to the arteriogram was readily identified and repaired. An unexpected benefit of completion arteriography has been its educational value with respect to surgical technique. Our early experience with unsuspected technical defects has led us to place greater emphasis on assuring luminal adequacy and avoiding arterial kinks. As a consequence, operative revisions have been required much less frequently. We strongly believe that intraoperative assessment to assure the technical adequacy of carotid reconstruction is imperative if optimal results are to be obtained. Routine completion arteriography proved highly satisfactory for this purpose, and its use improved operative technique.