General Surgery

Carotid Endarterectomy

OPERATION: Carotid Endarterectomy (Right / Left)
ANAESTHETIC: General [/ regional — superficial and deep cervical plexus block with local infiltration]
POSITION: Supine with head turned to contralateral side, neck slightly extended. Head ring.

INDICATION:
Symptomatic carotid artery stenosis [>70% / as per CAS criteria]. [TIA / minor stroke / amaurosis fugax]. [Carotid duplex / CTA/MRA — degree of stenosis].

PROCEDURE:
WHO Checklist performed. Head turned to contralateral side. Incision along the anterior border of sternocleidomastoid from mastoid process to suprasternal notch, centred over the bifurcation.

Sternocleidomastoid retracted laterally. Common facial vein ligated and divided. Internal jugular vein mobilised and retracted. Common, internal, and external carotid arteries dissected and controlled with slings.

Heparin [5000 IU] administered IV. [Baseline stump pressure measured / Doppler monitoring commenced / patient assessed neurologically if under regional anaesthesia].

Clamps applied: internal carotid first, then external, then common carotid. [Shunt inserted if indicated by cerebral monitoring / low stump pressure / neurological deterioration].

Longitudinal arteriotomy along the common carotid, extended into the internal carotid artery proximal and distal to the plaque. Endarterectomy plane established at the proximal common carotid and developed distally — atheromatous plaque mobilised and removed in continuity. Distal intimal endpoint tacked with 6/0 Prolene sutures if necessary to prevent dissection. Proximal endpoint trimmed.

Arteriotomy closed with [continuous 6/0 Prolene primary closure / bovine pericardium / saphenous vein / PTFE patch] taking careful bites. [Shunt removed before final sutures placed]. Clamps released: common carotid briefly to flush debris to external, then external, then internal carotid. Haemostasis confirmed.

Wound closed in layers. [Drain placed if required].

FINDINGS:
Significant atheromatous plaque at carotid bifurcation. Plaque removed complete. Distal intimal step: [flush / required tacking]. Backflow on release: [satisfactory].

EBL: [Volume] ml. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular neuro observations. Blood pressure monitoring and optimisation. Antiplatelet therapy continued. Carotid duplex at 30 days. Neurovascular outpatient follow-up.