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Carotid endarterectomy using a “home-constructed” shunt for patients intolerant to cross-clamping

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Abstract

Purposes

There is a small minority of patients with occlusive carotid artery disease, who are at high-risk for general anesthesia because of their intolerance to carotid flow blockage, even if only for seconds, without neurologic deficit. Even <30 s of temporary clamping of the carotid arteries to deploy a shunt may prove eventful in this patient group. We define safe carotid endarterectomy after the insertion of a novel shunt that we made from simple medical equipment in this patient population.

Methods

Among 65 patients who underwent carotid endarterectomy between March 2010 and December 2012, 5 (7.7 %; 3 men and 2 women; age range 56–77 years) could not tolerate carotid clamping. We used an alternative carotid shunt, made by us from simple equipment in our clinic, during surgery for these patients.

Results

Two patients had bilateral lesions and the remainder had unilateral disease. The degree of stenosis ranged from 70 to 95 %. Temporary carotid clamping resulted in neurologic events, such as loss of consciousness in all and tremor in one, in <10 s (range, from immediately to 8 s after clamping). Full neurologic function was regained 15–30 s after releasing the clamps. All of the patients tolerated the procedures well with the support of our novel shunt. Shunt flow was adequate in all patients and no neurologic deterioration occurred after carotid clamping. The mean carotid clamp time was 28.11 ± 14.19 min. There was no mortality and all patients were followed up for a mean period of 9.3 ± 3.6 months, uneventfully.

Conclusions

An alternative, simple shunt, which is easily constructed in the operating room or clinic, using an angiocatheter, a three-way stopcock, and a serum line can provide adequate cerebral flow and permit safe carotid endarterectomy for those rare patients with carotid artery stenosis, who cannot tolerate even seconds of carotid occlusion.

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Acknowledgments

We thank Ms. Melike Yazar for her technical support during the extracorporeal shunt flow studies and Mr Robert Moore for reading the script.

Conflict of interest

Murat Ugurlucan and the co-authors of this paper have no conflicts of interest.

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Authors and Affiliations

  1. Duzce Ataturk State Hospital, Duzce, Turkey

    Murat Ugurlucan, Muslum Ercument Filik, Ilker Murat Caglar & Ertugrul Zencirci

  2. Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Bozkurt Caddesi, No. 110-112, Benli Apartmani, Daire 6, Kurtulus, 80250, Istanbul, Turkey

    Murat Ugurlucan, Omer Ali Sayin & Murat Basaran

  3. Anadolu Medical Center Hospital, Cardiovascular Surgery Clinic, Gebze, Turkey

    Murat Ugurlucan, Omer Aydiner, Yahya Yildiz & Sertac Cicek

Authors
  1. Murat Ugurlucan
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  2. Muslum Ercument Filik
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  3. Ilker Murat Caglar
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  4. Ertugrul Zencirci
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  5. Omer Ali Sayin
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  6. Omer Aydiner
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  7. Yahya Yildiz
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  8. Murat Basaran
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  9. Sertac Cicek
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Correspondence to Murat Ugurlucan.

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Ugurlucan, M., Filik, M.E., Caglar, I.M. et al. Carotid endarterectomy using a “home-constructed” shunt for patients intolerant to cross-clamping. Surg Today 45, 284–289 (2015). https://doi.org/10.1007/s00595-014-0896-2

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  • DOI: https://doi.org/10.1007/s00595-014-0896-2

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