[et_pb_section fb_built=”1″ _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_row _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_audio title=”After longitudinal incision at the front edge of the sternocleidomastoid muscle (SCM), the incision was deepened through the platysma muscle, and the investing layer of the deep cervical fascia was opened on the anterior border of the SCM muscle. The anterior edge of the SCM muscle was mobilized, and the muscle was separated from the underlying vascular sheath by a sharp dissection on its medial border. By retracting the freed SCM muscle posteriorly, the carotid sheath was identified. The sheath was opened superior to the omohyoid muscle. The internal jugular vein was dissected along its medial border in the central part of the field and retracted posteriorly with the SCM muscle. The common facial vein was divided, as well as other medially coursing branches and the internal jugular vein was mobilized laterally. The ansa n. hypoglossi was pushed laterally. The common carotid artery (CCA) was isolated using sharp dissection before manipulation of the atherosclerotic bifurcation. The vagus nerve was identified and protected. The external carotid artery (ECA) was isolated just above the bifurcation. The internal carotid artery (ICA) was isolated next. Hypoglossal nerve was indentified in the distal part of ICA. Once the carotid bifurcation was exposed and Unfractionated Heparin (UFH) was administered (5000IU). ” _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_audio][et_pb_divider _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_divider][et_pb_image src=”https://https://https://https://https://https://https://https://https://https://https://https://esvs.org/wp-content/uploads/2025/08/masterclass-3-2.png-preprod2.kwantic.dev/wp-content/uploads/2025/09/Mask-group-18-3.png-preprod2.kwantic.dev/wp-content/uploads/2025/08/featured-2.png-preprod2.kwantic.dev/wp-content/uploads/2017/04/news-https://https://https://esvs.org/wp-content/uploads/2025/08/masterclass-3-2.png-preprod2.kwantic.dev/wp-content/uploads/2025/09/Mask-group-18-3.png-preprod2.kwantic.dev/wp-content/uploads/2025/08/featured-2.png-1-2.jpg-preprod2.kwantic.dev/wp-content/uploads/2025/08/masterclass-3-1.png-preprod2.kwantic.dev/wp-content/uploads/2025/09/Mask-group-18-2.png-preprod2.kwantic.dev/wp-content/uploads/2025/08/featured-1.png-preprod2.kwantic.dev/wp-content/uploads/2017/04/news-https://https://https://https://https://https://https://esvs.org/wp-content/uploads/2025/08/masterclass-3-2.png-preprod2.kwantic.dev/wp-content/uploads/2025/09/Mask-group-18-3.png-preprod2.kwantic.dev/wp-content/uploads/2025/08/featured-2.png-preprod2.kwantic.dev/wp-content/uploads/2017/04/news-https://https://https://esvs.org/wp-content/uploads/2025/08/masterclass-3-2.png-preprod2.kwantic.dev/wp-content/uploads/2025/09/Mask-group-18-3.png-preprod2.kwantic.dev/wp-content/uploads/2025/08/featured-2.png-1-2.jpg-preprod2.kwantic.dev/wp-content/uploads/2025/08/masterclass-3-1.png-preprod2.kwantic.dev/wp-content/uploads/2025/09/Mask-group-18-2.png-preprod2.kwantic.dev/wp-content/uploads/2025/08/featured-1.png-1-1.jpg-preprod2.kwantic.dev/wp-content/uploads/2025/08/masterclass-3.png-preprod2.kwantic.dev/wp-content/uploads/2025/09/Mask-group-18.png-preprod2.kwantic.dev/wp-content/uploads/2025/08/featured.png-preprod2.kwantic.dev/wp-content/uploads/2024/03/Carotid-bifurcation.jpg” title_text=”Carotid bifurcation” _builder_version=”4.23.4″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″ align=”center”][/et_pb_image][et_pb_divider _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_divider][et_pb_audio title=”Interestingly according to the latest ESVS carotid and antithrombotic guideline there are no recommendations about the intraoperative anticoagulation during carotid cross clamping. There is only recommendation for the use of Unfractionated Heparin and Bivalirudin during open and endovascular arterial procedures, which is based on an expert consensus and one meta-analysis of small observational trials.” _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_audio][et_pb_divider _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_divider][et_pb_code _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”]
[/et_pb_code][et_pb_blurb _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”]Source: Twine CP, Kakkos SK, Aboyans V, Baumgartner I, Behrendt CA, Bellmunt-Montoya S, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. Eur J Vasc Endovasc Surg. 2023;65(5):627-689.
[/et_pb_blurb][et_pb_divider _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_divider][et_pb_audio title=”After UFH administration the common carotid artery (CCA), external carotid artery (ECA), and internal carotid artery (ICA) have been clamped. There were no significants drops of motor and somatosensory evoked potential values during 3 min probe period of carotid cross-clamping, therefore operating surgeon decided not to use shunting during carotid endarterectomy (CEA). The surgeon performed longitudinal incission and using fine dissectors the optimal plane between inner and outer medial layers was entered. The distal part of intima in the ICA was fixated with three Prolen 6-0 sutures, and bovine pericardium was used to close the arteriotomy. The intraoperative course was uneventful and patient was transfered in intensive care unit (ICU) for further monitoring.” _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_audio][et_pb_divider _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_divider][et_pb_audio title=”The following video will describe all important technical aspects when performing carotid endarterectomy with patch plasty” _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_audio][et_pb_divider _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_divider][et_pb_code _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_code][et_pb_divider _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_divider][et_pb_audio title=”And the following articles describe closure technique using patch after carotid endarterectomy” _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_audio][et_pb_code _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”]
[/et_pb_code][et_pb_audio title=”According to the latest ESVS guidelines, when performing conventional endarterectomy it is recommended to proceed with routine patch closure compared to primary closure due to reduced rate of stroke and restenosis” _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_audio][et_pb_code _builder_version=”4.23.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_code][/et_pb_column][/et_pb_row][/et_pb_section]
