Is the retrojugular approach safer than the conventional approach for carotid endarterectomy?

Abstract

The retrojugular approach is promoted as an alternative to traditional antejugular carotid endarterectomy. Absence of named posterior venous branches and ease of distal internal carotid dissection reduce time for carotid exposure together with improved distal exposure. However, a higher incidence of local nerve injury and persistent hoarse voice has been reported. We compare the incidence of these and other complications for the antejugular and retrojugular approaches. This is a nonrandomised retrospective review of prospectively collected data on consecutive patients undergoing carotid endarterectomy. Our 178 patients formed two groups who were homogeneous in terms of sex and age. Mean operative times, patch usage, and general/local anaesthesia did not differ significantly for the two groups. Postoperative complications including transient ischemic attack (TIA), major stroke, or death; hypertension; miosis; and hypoglossal injury were similar for the two groups. However, there was a significantly increased incidence of persistent hoarse voice (p < 0.05) in the retrojugular group. Reports of increased incidence of persistent hoarse voice associated with the retrojugular approach to carotid endarterectomy are supported by our findings, which point to a learning curve effect. A randomized controlled trial would be necessary before any strong recommendation could be made for or against the retrojugular approach.