Retrojugular Carotid Endarterectomy –A Prospective study.

T Joseph, S J Robinson, E Grocott.
Institution: Worcestershire Royal Hospital, Worcester, UK

Aim: To compare the safety and outcome of antejugular and retrojugular approach to carotid endarterectomy.

Methods: Consecutive patients who underwent carotid endarterectomy under single surgeon had their preoperative, operative and post-operative data collected prospectively which included 6-week review by the surgeon and neurologist.

Results: A total of 278 patients (189 men, 89 women) underwent carotid endarterectomy (156–antejugular, 122-retrojugular). Their median age was 71 years (range 40-89). There was no significant difference between the two groups on comparing the demographics, risk factors and indications except for number of pre-CABG-patients where the cohorts were small.
 
Table comparing operative-factors and complications.

There was one death in the ante-jugular group who had carotid endarterectomy for a symptomatic 99% stenosis, following occlusion of asymptomatic contralateral side (90% stenosis).

Conclusion: Retro-jugular approach to carotid artery is safe and it is quicker to perform with significantly less blood-loss. It gives better exposure when higher dissection is necessary.