Intraoperative duplex scanning as a means of quality control during carotid endarterectomy.

Abstract

To identify correctable technical errors following carotid endarterectomy using intraoperative colour duplex sonography (ATL, UM9, HDI). Results were compared with intraoperative flow measurements using an operative flow meter and with middle cerebral artery velocity measured by trans-cranial Doppler (TCD). Prospective study. 50 consecutive patients undergoing carotid endarterectomy were investigated. Follow-up was performed at 6 weeks using duplex scanning and clinical evaluation. Significant intraoperative technical errors were detected in three patients and were re-explored. Two scans demonstrated kinking or pinching at the distal endarterectomy site requiring patch-plasty and the third revealed a large mass of intramural thrombus. A further 18 endarterectomies yielded 21 additional minor abnormalities. Duplex sonography provides a sensitive intraoperative technique for detecting thrombus and technical errors. It yields both anatomic and hemodynamic details and is superior to intraoperative flow measurements and transcranial doppler.