Evolving techniques in the treatment of carotid artery kinking: The use ofresected redundant arterial segment

Internal carotid artery kinking is frequently accompanied by atheromatous d isease at the carotid bifurcation, and in this case both lesions may be tre ated simultaneously. Various surgical techniques have been used to correct carotid kinking but no particular one has been widely established. We condu cted a retrospective review of 18 patients operated upon for internal carot id kinking during the last 5 years, which represents 4.1 per cent of the to tal carotid procedures performed during the same period. In 13 of the 18 pa tients carotid endarterectomy was performed before the repair of the kink. In four patients resection of the kinked segment with end-to-end anastomosi s was performed combined with longitudinal arteriotomy at the carotid bifur cation. Two patients developed restenosis at the site of anastomosis requir ing reoperation with patch angioplasty. Three patients were treated with ev ersion endarterectomy and end-to-side anastomosis, whereas in six patients we performed resection of the redundant internal carotid artery combined wi th longitudinal arteriotomy at the bifurcation. The posterior wall was reco nstructed with interrupted sutures and the procedure was completed with pat ch angioplasty of the anterior wall. In four of these cases we used the aut ogenous resected arterial segment as patch material. None of these patients developed restenosis or symptoms in a follow-up period of 3 to 32 months. In cases in which significant carotid artery stenosis and internal carotid kinking coexist resection of the involved segment with end-to-end anastomos is of the posterior wall and patch angioplasty using the resected autogenou s arterial segment constitute a convenient and satisfactory method of recon struction.