Prevention of Back Bleeding During Carotid Endarterectomy: Analysis of Clamping Techniques

• Published in: World neurosurgery Vol. 131; pp. e186 - e191
• Main Authors: Tomonori, Tamaki, Fumihiro, Matano, Michio, Yamazaki, Akio, Morita
• Format: Journal Article
• Language: English
• Published: United States 01-11-2019
• Subjects: Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Carotid Stenosis - surgery; Computed Tomography Angiography; Constriction; Endarterectomy, Carotid - methods; Female; Hemodynamics; Humans; Intraoperative Complications - epidemiology; Male; Multidetector Computed Tomography; Pharynx - blood supply; Platelet Aggregation Inhibitors - therapeutic use; Retrospective Studies; Risk Factors; Severity of Illness Index; Vascular Calcification - surgery; Common carotid artery; Carotid endarterectomy; Atherosclerosis
• DOI: 10.1016/j.wneu.2019.07.114
• EISSN: 1878-8769
• ISSN: 1878-8750

Complete control of back bleeding during carotid endarterectomy (CEA) is important. We investigated the causes of back bleeding during CEA and techniques for the control of bleeding.
A retrospective review was performed of 214 CEA procedures. We assessed the results of routine preoperative examinations, instruments used for arterial clamping (vessel loop and crude or bulldog clamps), and severity of carotid artery stenosis and arterial wall calcification. The study end point was incomplete control of back bleeding before arteriotomy. Factors associated with back bleeding were identified by univariate analysis. The culprit artery and intraoperative technique used in patients with back bleeding were also determined.
Transient back bleeding occurred in 19 CEA procedures (8.9%). Back bleeding was from the ascending pharyngeal artery in 9 cases, common carotid artery in 8 cases, and external carotid artery in 2 cases. Univariate analysis identified the following factors as being related to incomplete control of back bleeding: moderate carotid artery stenosis (20 mm thick) and use of bulldog clamps.
Transient back bleeding during CEA was uncommon, with the risk factors being severe carotid calcification and moderate carotid stenosis. Transient back bleeding was managed by clamping an undetected ascending pharyngeal artery or by additional clamping of the common carotid or external carotid artery. The vessel loop and crude were superior to the bulldog clamp for clamping the carotid artery.