頚動脈内膜剝離術におけるプラーク剝離の工夫─初心者の視点から─

抄録

The basic procedure of carotid endarterectomy (CEA) has been almost established. However, beginners sometimes have difficulty dissecting the plaque at the same plane and treating the distal end of the plaque, even in typical cases. A simple, safe, and standardized procedure is important for beginners. We use the internal shunt in all cases to secure adequate blood flow and take advantage of the shunt tube as the tool for plaque dissection at the distal end.
We introduce our surgical technique and review our procedure from a beginner's point of view. We tack up the skin, muscle, and carotid sheath by using sutures to make wide and shallow operative fields without retractors. We insert the internal shunt tube after arteriotomy. Beginners need to rehearse the tube insertion before the procedure. At the proximal side of the plaque, we connect both sides of the dissection plane across the shunt to secure the same plane.
The distal end of the intima of the internal carotid artery (ICA) is fastened by using a shunt tube and tourniquet. The plaque can be easily cut off at the position of the tourniquet. If the plaque remains, we can peel off the plaque remnant like peeling onion skin. A shunt tube is used as the template of the ICA lumen in the distal end.
Beginners can easily master these procedures, which can be performed safely without distress, even in high-positioned stenosis. These procedures enable the beginners to accomplish CEA securely.