Carotid endarterectomy

Carotid endarterectomy

Anesthesia type	GETA vs. regional anesthesia
Airway	Endotracheal Tube
Lines and access	PIV x 2 18 ga or larger is adequate
Monitors	Standard monitors, arterial line
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
Editor rating	Comprehensive
User likes	2

Carotid endarterectomy (CEA) is a surgical procedure for treating occlusive atherosclerotic disease involving the common and internal carotid arteries. The procedure is more effective than medical management for patients with high grade stenosis (70–99%), symptomatic moderate stenosis (50-69%), or asymptomatic high-grade stenosis (≥ 60%). CEA involves making a longitudinal incision along the anterior border of the sternocleidomastoid muscle to expose the common, internal, and external carotid arteries as well as the carotid sinus. The carotid artery is then opened and the atherosclerotic plaque is removed. Opening of the carotid artery requires occlusion of the proximal common carotid and distal internal and external carotid arteries, which requires adequate collateral flow from the contralateral common carotid artery or placement of an internal shunt between the proximal common carotid and the distal internal carotid arteries. On removal of the atherosclerotic plaque, the media and adventitia of the arteries may be re-approximated or a graft may be used. These grafts are typically synthetic, but vein grafts are occasionally used.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Intraoperative management

Positioning

Patients are positioned supine with the head turned away from operative site. Beach chair may be used for comfort in awake patients

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications