INTRAOPERATIVE HIGH-RESOLUTION DUPLEX IMAGING DURING CAROTID ENDARTERECTOMY - WHICH ABNORMALITIES REQUIRE SURGICAL-CORRECTION

Objectives: This study evaluates high resolution, duplex ultrasound im aging for quality control of carotid endarterectomy in order to determ ine which technical factors were linked to residual stenosis and to de fine duplex criteria for reexploration. Design, material and methods: A consecutive series of 100 patients undergoing carotid endarterectomy were evaluated. Duplex imaging was performed prior to wound closure a nd repeated at 6-8 weeks postoperatively. Stenoses were classified as non-significant, moderate or severe based on duplex criteria. Intimal flaps, shelves, kinks, clamp damage and fronds were identified by ultr asound imaging. Results: Five moderate stenoses were noted in the prox imal endarterectomy site (PES), and at follow-up three had resolved. A dherent fronds were detected in 83% of vessels and resolved in all but three cases. At the distal endarterectomy site there were 10 severe a nd 12 moderate stenoses. Intimal flaps were associated with an increas ed incidence of residual stenosis (p = 0.010). Conclusions: We conclud e that severe stenoses with an intimal flap should be corrected immedi ately. Further data is required to establish the significance of kinks . Residual intimal flaps in the PES appear to remodel. The role of com pletion duplex may lie in the modification of surgical technique to er adicate anatomical and haemodynamic imperfections.