SCVS Main Site  |  Past and Future Meetings
Society For Clinical Vascular Surgery

Back to 2019 Abstracts


Carotid Bypass after Temporary Balloon Occlusion of the Internal Carotid Artery using Transcranial Doppler to Assess Tolerance of Ligation for Patch Infection
Travis J. Vowels, MD, Zsolt Garami, MD, Alan B. Lumsden, MD.
Houston Methodist Hospital, Houston, TX, USA.

OBJECTIVES: Patch infection is a rare complication of carotid endarterectomy (CEA), occurring in less than 1% of patients after CEA. Multiple treatment options for this potentially devastating complication have been described including bypass or patch angioplasty with autologous vein or artery, internal to external carotid artery transposition, and ligation of the internal carotid artery (ICA). Ligation of the ICA is associated with a prohibitive risk of major stroke and death in this population. In this video we demonstrate a carotid bypass after temporary balloon occlusion of the ICA with transcranial Doppler (TCD) monitoring reveals the inability of a patient to tolerate ICA ligation for patch infection.
METHODS: The patient is a 73-year-old female with history of right CEA 14 years prior to presentation and redo right CEA two years prior with a prosthetic patch for symptomatic restenosis who presented to us with a draining right neck sinus tract. Imaging findings were consistent with carotid patch infection. We performed temporary balloon occlusion of her right ICA to assess tolerance of ligation during carotid patch excision.
RESULTS: In this video, we first demonstrate distal balloon occlusion of the ICA using TCD and awake neuromonitoring. Upon balloon inflation, there is a significant drop in her middle cerebral artery velocities and an immediate change in her neurological status demonstrating lack of tolerance to ICA ligation. We then showcase a common carotid to internal carotid artery bypass using reversed greater saphenous vein with intraoperative shunting.
CONCLUSIONS: We illustrate that test balloon occlusion of the ICA and intraoperative TCD monitoring can be used to assess whether a patient can tolerate ligation of the ICA during patch excision for infection.


Back to 2019 Abstracts