Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3660_Библиотеки_им_академика_М_И_Перельмана

When it is necessary to open the ECA endarterectomy as a separate Y-shaped incision as previously mentioned, I prefer to begin by repairing the ECA arteriotomy rst. An anchor stitch is placed distal to the apex of the ECA arteriotomy, and working distally to proximally, a continuous interrupted non-locking suture is placed. At the carotid bulb, a separate single stitch is thrown and tied, and the free end of the continuous ECA stitch is tied to this. The other free end of the single stitch can then be incorporated into the main arteriotomy suture line. This gure demonstrates a complete ECA repair.

When the ICA suture line has been brought down to the region of the carotid bulb, the 6-0 Prolene is secured with a rubber-shod mosquito clamp and draped away from the eld. A second arm of the suture line is brought up from the CCA. This begins by taking a large full-thickness bite proximal to the apex of the arteriotomy in the CCA. The same type of equal bites are then taken to create a suture line that comes up until it meets the ICA suture line in the region of the carotid bulb. The bites in the CCA need not be as ne because the potential for creating a stenosis is much less. I customarily have the CCA suture line performed by the assistant since a right-handed assistant will place the bites from right to left just as the primary surgeon did in the ICA. In this way, the needles will come out on opposite sides of the vessel at the carotid bulb and the knot will lie across the arteriotomy wall rather than having both stitches on the same side. I think this is important to secure adequate hemostasis at the point where the two suture lines are brought together.