Technical aspects of carotid endarterectomy with Hemashield patch graft

In this review I describe my method of carotid endarterectomy with synthetic patch angioplasty. The use of Hemashield patch angioplasty is relatively new in my practice, and since I have adopted it I feel it has reduced or eliminated early restenosis and acute postoperative occlusion. The technique is simple and straightforward, and does not require any special preparation of the patch material. The patch is stronger and safer than saphenous vein. The other steps of the endarterectomy are unchanged, and the same suture can be used for patch placement. I also describe here a new commercial shunt which I have developed and which I feel is an improvement over the shunts I previously used. I place an indwelling shunt selectively, if electroencephalography criteria indicate that a shunt is needed. In my series this occurs in 15% of cases, increasing to 25% in patients with contralateral carotid artery occlusion. The overall stroke rate in my carotid artery series is 1.8% at present.