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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 1998 September;5(3):151-7
language: English, Italian
Surgical correction of tortuosities and symptomatic kinking of the internal carotid artery using a replantation technique. Personal experience
Angelini R., Marinucci R., Di Nardo E., Santarelli M., Ucchino S., Spigonardo F.
From the Vascular Surgery Operating Unit AUSL Chieti, Italy
Background. The authors report their experience of internal carotid artery (ICA) replantation.
Methods. Between 1990 and 1997 a total of 412 patients underwent carotid surgery. In 33 cases carotid surgery was associated with another operation. In this series 42 patients (11.9%) underwent ICA replantation. 14 patients revealed symptomatic kinking, 9 of which were operated bilaterally; 19 presented marked tortuosity of the ICA associated with hemodynamically significant and/or symptomatic stenosis affecting the same artery. The aim of this study was to illustrate the replantation technique used and the medium-term results (follow-up of 1-65 months, mean follow-up 35.5 months). The scope of surgery was to eliminate the elongation causing the underlying dysmorphia, as well as treating any associated lesions. The technique used can be divided into two basic stages:
— exposure and freeing of dysmorphia;
— transverse resection of ACI, eversion TEA, longitudinal arteriectomy of the common carotid artery, TEA of the latter, end-to-end anastomosis of the ICA and common carotid artery. A total of 35 patients (83.3%) were followed up.
Results. Three patients died (7%). One patient died 4 months later for reasons directly linked to surgery, due to the consequences of cerebral hemorrhage which occurred eight hours after the operation (2.38%); two died from other causes (AMI in both cases after 24 and 30 months of follow-up) (4.76%). The remaining 32 patients were controlled as outpatients and underwent colour Doppler sonography (32 out of 32) and angiography (18 patients, 42.8%).
Conclusions. Good patency was observed in all replantations with no residual functional deficits.