Surgical Anatomy and Technique for Carotid Endarterectomy

Abstract

Based on our clinical experience of 240 cases, we present the noticeable anatomical structures and our principles of procedures during carotid endarterectomy (CEA). We also present a newly developed self-retaining retractor and spring hook for CEA. The noticeable anatomical structures are as follows: the internal jugular and facial veins, the hypogrossal nerve and ansa cervicals, vagus nerve, superoir laryngeal nerve, and branches of the external carotid artery. Our principles of exposure of the carotid arteries during CEA are the meticulous anatomical dissection and identification of the cervical structures and the intentional circumferential dissection of the carotid complex. Our perioperative cerebral complication rate (mortality and morbidity) is 2.4%, and the incidence of the basic technical complications such as cranial nerve palsy and wound hematoma are 0.4% and 1.3%, respectively. The meticulous anatomical dissection and the intentional circumferential dissection of the carotid complex are essential to minimize postoperative complications.