Novel Simple Closure of Arteriotomy in Carotid Endarterectomy

Abstract

Suturing of arteriotomy is the most crucial step in carotid endarterectomy (CEA). We modified our suturing technique to simplify it and compared it with previous other methods. Following arteriotomy and plaque removal, the center of arteriotomy is sutured as a stay suture. Subsequently, running sutures are initiated from the internal carotid artery (ICA) side to the center and completed by tying with the central stay suture. Another running suture is initiated from the common carotid artery (CCA) side to the center. The last three sutures are kept loose to irrigate the lumen and flush the open arteriotomy. The thread of the loosened suture is tightened, and the closure is completed by tying with the central stay suture. Several methods for closure of arteriotomy have been reported combining running or interrupted sutures in CEA. Our novel tightening technique was developed based on a cardio-vascular surgery technique, and it provided quick closure after the flushing step. In surgical procedures, preference is given to simple techniques to avoid complications.