Eversion Carotid Endarterectomy: Indications, Techniques, Pitfalls, and Complications

Abstract

Eversion carotid endarterectomy (ECEA) is an alternative method of plaque extirpation by oblique transection of the internal carotid artery at its origin near the carotid bifurcation and subsequent reimplantation of the ICA into the carotid bulb. Carotid duplex ultrasonography is currently the preferred imaging modality for the diagnosis of carotid artery stenosis due to its safety, availability, and reliable results. Advantages of eversion versus standard endarterectomy include the ability to shorten a redundant ICA, better visualized end point and easier detection of intimal flaps, faster closure by simple anastomosis of the ICA to the carotid bulb, an all-autogenous reconstruction, and decreased restenosis rates in women. Although the eversion method has not shown superior results conclusively, ECEA allows for another reliable technique that should be in every vascular surgeon’s armamentarium for the surgical intervention of high-grade carotid occlusive disease.