Sinus-saving modification of eversion carotid endarterectomy as a method of stabilization perioperative arterial hemodynamics

Abstract

Introduction: In surgery of the carotid arteries, from all known techniques of carotid endarterectomy, eversion technique has several important advantages. It helps to avoid the longitudinal arteriotomy, patch angioplasty and reduces the length of operation. However the standard version of it is attended with damage of carotid sinus nerve, which has a negative impact on perioperative arterial hemodynamics with a tendency to hypertension. Our goal is to develop an operative technique that could let us avoid intersection of the carotid sinus nerves, which reduce the risk of complications thanks to a more manageable blood pressure, due to decreased sympathetic influence on the regulation of vascular tone. Materials and methods: The research included 193 patients operated on carotid arteries in Chelyabinsk Regional Clinical Hospital since 2012 to 2015.Groups are even in age, sex, initialneurological and cardiac status and contralateral blood flow. The first group included 98 patients with eversion technique with the intersection of the carotid sinus nerves. The second group included 95 patients who had been used a modified technique, with saved carotid sinus nerves. On the 1st and 4th day after surgery the state of the autonomic regulation was assessed by analyzing heart rate variability. Discussion results: In the group of patients with saved carotid sinus nerve on the 1st day after surgery was more than noticeable decrease sympathetic influence on the rhythm, with a tendency to restore autonomic regulation on the 4th day. Conclusion: 1. Obtained results show lower activity of the sympathetic and the higher activity of the parasympathetic system in the group with non-damaged carotid sinus nerves. 2. Application glomus-saving technology in carotid surgery reduces the risk of patient complications Associated with postoperative hypertension.