Dos Santos Reinaldo Benevides, Queiroz André Brito, Fidelis Ronald José Ribeiro, Lopes Cicero Fidelis, de Araújo José Siqueira
Hospital Ana Nery - HAN, Departamento de Cirurgia Vascular, Salvador, BA, Brasil.
Hospital Universitário Professor Edgard Santos - HUPES, Departamento de Cirurgia Vascular, Salvador, BA, Brasil.
J Vasc Bras. 2017 Oct-Dec;16(4):329-334. doi: 10.1590/1677-5449.001117.
Atherosclerotic disease of the extracranial carotid arteries can cause complications with high morbidity and mortality rates. The contrast imaging examinations used in preoperative evaluation are associated with complications such as parotitis, in addition to well-known allergic reactions and renal dysfunction. A high carotid bifurcation or atherosclerotic disease that extends distally are often limiting factors for conventional surgical treatment. However, when iodinated contrast is contraindicated or endovascular treatment is not feasible, knowledge of surgical techniques that allow safe endarterectomy is required. Subluxation of the mandible has proven to be a safe and effective adjuvant technique that is easy to perform and reproducible, providing access to high carotid bifurcations with good exposure of the surgical field and allowing endarterectomy to be performed with a standard technique. We present the case of a patient with a high carotid bifurcation and limitations for use of iodinated contrast who underwent carotid endarterectomy after subluxation of the mandible.
颅外颈动脉粥样硬化疾病可导致并发症,其发病率和死亡率都很高。术前评估中使用的造影成像检查除了会引发众所周知的过敏反应和肾功能障碍外,还会导致腮腺炎等并发症。高位颈动脉分叉或向远端延伸的动脉粥样硬化疾病常常是传统手术治疗的限制因素。然而,当禁忌使用碘化造影剂或血管内治疗不可行时,就需要了解能确保安全实施动脉内膜切除术的手术技术。事实证明,下颌骨半脱位是一种安全有效的辅助技术,操作简便且可重复,能够暴露高位颈动脉分叉,使手术视野良好,从而可以采用标准技术实施动脉内膜切除术。我们在此呈现一例高位颈动脉分叉且使用碘化造影剂受限的患者,该患者在接受下颌骨半脱位术后进行了颈动脉内膜切除术。