title: Use of intraoperative duplex ultrasonography for identification and patch repair of kinking stenosis after carotid endarterectomy: a single-surgeon retrospective experience.
abstract: OBJECTIVE
  To provide an incidence and descriptive evaluation of kinking of the internal carotid artery (ICA) after carotid endarterectomy (CEA) in a consecutive CEA series that included the use of intraoperative duplex ultrasonography (IDUS) monitoring and to determine the effect of kink patch repair on long-term postoperative ICA restenosis.
  
  
  METHODS
  The electronic medical records and IDUS recordings of all CEA cases performed over a 10-year period (March 2000 to October 2010) by a single neurosurgeon were retrospectively reviewed to assess cases of kinking after CEA.
  
  
  RESULTS
  IDUS assisted in the identification of 27 of 285 cases (9.5%) of kinking after CEA. Kinked vessels with hemodynamically significant peak systolic velocities of ≥ 120 cm/second on IDUS (11 of 285 cases; 3.9%) were repaired using a synthetic patch. During follow-up, there were no neurologic symptoms, stroke, or death related to a cerebrovascular accident associated with kinking. The total incidence of postoperative stroke in this CEA series was 3 of 285 cases (1.1%).
  
  
  CONCLUSIONS
  ICA kinking stenosis after CEA was a common finding in this CEA series. Because of their unique anatomic and hemodynamic properties, the identification and assessment of kinks after CEA required the use of IDUS monitoring. A selective patch closure method for kinked vessels with peak systolic velocities of ≥ 120 cm/second identified by IDUS was effective in resolving hemodynamically significant stenosis and minimizing long-term postoperative restenosis.
authors.affiliation: Sanford School of Medicine of The University of South Dakota, Vermillion, South Dakota, USA. Electronic address: jasonyyuan@gmail.com.
authors.forename: Jason Y
authors.initials: JY
authors.lastname: Yuan
authors.affiliation: Sanford School of Medicine of The University of South Dakota, Vermillion, South Dakota, USA; Center for Neuroscience, Orthopedics, and Spine (CNOS), Dakota Dunes, South Dakota, USA.
authors.forename: Quentin J
authors.initials: QJ
authors.lastname: Durward
authors.affiliation: Center for Neuroscience, Orthopedics, and Spine (CNOS), Dakota Dunes, South Dakota, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Pary
authors.affiliation: Center for Neuroscience, Orthopedics, and Spine (CNOS), Dakota Dunes, South Dakota, USA.
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Vasgaard
authors.affiliation: Center for Neuroscience, Orthopedics, and Spine (CNOS), Dakota Dunes, South Dakota, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Coggins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*