Gasida They smelled of tobacco and sweat. Rua Estela,bloco E, conj. This study showed a global bleeding rate of The work of a writer is a part carogidea life, it is an individual and collective experience that seeks, finds, takes and uses its materials like a motor machine. Temas selectos en medicina interna pdf document.
|Published (Last):||20 May 2006|
|PDF File Size:||12.75 Mb|
|ePub File Size:||3.87 Mb|
|Price:||Free* [*Free Regsitration Required]|
Procedure[ edit ] Illustration depicting a Carotid Endarterectomy An incision is made on the midline side of the sternocleidomastoid muscle. The internal, common and external carotid arteries are carefully identified, controlled with vessel loops, and clamped.
The lumen of the internal carotid artery is opened, and the atheromatous plaque substance removed. The artery is closed using suture and a patch to increase the size of the lumen.
Hemostasis is achieved, and the overlying layers closed with suture. The skin can be closed with suture which may be visible or invisible absorbable.
Many surgeons place a temporary shunt to ensure blood supply to the brain during the procedure. The procedure may be performed under general or local anaesthesia. The latter allows for direct monitoring of neurological status by intra-operative verbal contact and testing of grip strength. With general anaesthesia, indirect methods of assessing cerebral perfusion must be used, such as electroencephalography EEG , transcranial doppler analysis and carotid artery stump pressure monitoring.
At present there is no good evidence to show any major difference in outcome between local and general anaesthesia. Minimally invasive procedures have been developed, by threading catheters through the femoral artery , up through the aorta , then inflating a balloon to dilate the carotid artery, with a wire-mesh stent and a device to protect the brain from embolization of plaque material. The FDA has approved 7 carotid stent systems as safe and effective in people at increased risk of complications for carotid surgery and 1 carotid stent system for people at average or usual risk of carotid surgery.
A study of people at high surgical risk for carotid surgery demonstrated non-inferiority for carotid stenting compared to carotid surgery. However, carotid endarterectomy was associated with a slightly higher rate of myocardial infarction around the time of the procedure 2. In an Argentinian surgeon repaired a carotid artery occlusion using a bypass procedure. The first endarterectomy was successfully performed by Michael DeBakey around , at the Methodist Hospital in Houston, TX, although the technique was not reported in the medical literature until In nearly , carotid endarterectomies were performed in the USA.
Journal of Vascular Surgery.