Operative Note

A longitudinal incision was made along the anterior border of the sternocleidomastoid muscle.  The underlying skin and the platysma muscle were divided using electrocautery.  The underlying carotid sheath was identified.  The left common carotid, internal and external carotid arteries were dissected free from their surrounding structures and encircled with vessel loops.  The left internal carotid artery was dissected free above the left internal carotid lesion. The patient was systemically heparinized.  Proximal and distal control was obtained and then a longitudinal arteriotomy was made beginning in the distal common carotid artery and extending into the left internal carotid artery beyond the lesion.  A Sundt shunt was placed for intraoperative cerebral profusion.  A standard carotid endarterectomy was performed removing the large amount of internal carotid artery plaque.  The distal end point was tacked with interrupted 7-0 Prolene sutures. The loose fibrointimal debris was removed.  Prior to proximal and distal control, the patient was systemically heparinized.  The arteriotomy was closed using a Dacron patch angioplasty.  The patch was placed using a running 6-0 Prolene suture.  Prior to completion of the patch angioplasty the shunt was removed. The internal carotid artery was noted to have good backbleeding and there was good flow via the left common carotid artery.  Once the shunt was removed, the patch angioplasty was closed.  The Doppler was used to confirm good flow signals within the common carotid and internal and external carotid arteries.  Thrombin and Gelfoam were used for hemostasis. 

A 7 mm flat Jackson-Pratt drain was placed in the wound and the wound was closed in multiple layers using running 2-0 and 3-0 Vicryl sutures.  The skin was reapproximated with staples. 

A sterile dressing was then applied. At the conclusion of the procedure the patient extubated and transported to the recovery room for further care and monitoring.