Advantage of the retrojugular mini-longitudinal approach with alternative wound drainage in carotid endarterectomys

Currently, there is a tendency in carotid endarterectomy to clarity, safety, low trauma and without loss of quality of life of the patient. Particular attention after surgical treatment of the carotid artery is paid to iatrogenic local complications, such as: neuropathy of the cranial nerves, hematoma of the postoperative wound, bleeding, thrombosis in the anastomosis area with the development of cerebral infarction, cosmetic defect. The issue of carotid access and wound drainage is actively discussed taking into account local complications, postoperative quality of life. This study proposes a method of active drainage through the main wound in combination with minimally invasive retrojugular access to the bifurcation of the carotid artery. Comparative calculations were made between different approaches to the carotid bifurcation, early and late postoperative complications were compared taking into account the access. With the classical approach to the carotid bifurcation, compared with the retrojugular approach, there was a higher frequency of neurological symptoms, including skin hypoesthesia (3.8% and 33.3%, p = 0.01), the risk of MACE within 9 months increased 8.18 times (HR = 8.181, 95% CI 2.086–32.086, p = 0.003) compared with the antegular mini-approach. A model for predicting postoperative cranial nerve neuropathy was developed an increase in the incision length by 1 cm increases the likelihood of achieving a secondary endpoint (OR = 2.264; 95% CI: 1.300–3.943, p = 0.004).

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