DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Right internal carotid artery stenosis.
2. Status post right hemispheric cerebrovascular accident.
POSTOPERATIVE DIAGNOSES:
1. Right internal carotid artery stenosis.
2. Status post right hemispheric cerebrovascular accident.
OPERATION PERFORMED: Right carotid endarterectomy with patch.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
BLOOD LOSS: Minimal.
PROCEDURE FINDINGS:
1. Heavily calcified, nearly occlusive, ulcerative plaque in proximal internal carotid artery.
2. Excellent bleeding from internal carotid artery, therefore, no shunt was used.
3. Dacron patch used at conclusion of endarterectomy.
4. The patient awoke from anesthesia with no neurologic deficit.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, where support lines were placed and general anesthesia was secured. The right neck was prepped and sterilely draped. An oblique incision was made along the anterior border of the right sternocleidomastoid muscle. The platysma was divided and dissection was done down to the carotid sheath. The facial vein was doubly ligated and divided exposing the carotid bifurcation. The vagus nerve and XII nerve were identified and kept free from dissection and retraction. The internal, external, and common carotid arteries were dissected free proximally and distally. Heparin 5000 units was given intravenously. All these vessels were encircled with vessel loops. Once the heparin was allowed to circulate for approximately 5 minutes, clamps were placed. An anterior arteriotomy was made on the common carotid artery. Potts scissors was used to extend the arteriotomy through the plaque on to the distal soft internal carotid artery. The plaque was very heavily calcified, ulcerated, and nearly occlusive. The internal carotid artery clamp was released revealing excellent backbleeding; therefore, no shunt was used. A Freer elevator was used to create an endarterectomy plane. The proximal endpoint was created using Potts scissors. An eversion endarterectomy was performed of the external carotid artery. With downward retraction on the plaque, a smooth distal endpoint was created. All debris was meticulously debrided from the inside of the lumen and confirmed with instillation of heparinized saline. Once endarterectomy was completed, a Dacron patch was then cut to the appropriate size and sewn into internal carotid artery. It was sewn in circumferentially using 5-0 Prolene suture. Before the patch was completed, all the arteries were backbled extruding any air and debris. The patch was then completed. The external carotid clamp was removed first, followed by the common carotid artery clamp, and finally the internal carotid artery clamp, restoring blood flow to the brain. There was an excellent distal pulse and good distal signal with Doppler. Protamine 50 mg was administered intravenously. Meticulous hemostasis was secured. The wound was then closed in multiple layers using Vicryl suture. The patient tolerated the procedure well and was extubated on table. The patient was moving all four extremities to command upon transfer to the recovery room.
