Page 99 - Libro 2

6
Ultrasound Following Surgery and Intervention
Clifford T. Araki, Cynthia Cannon, Gwendolyn Carmel, Jesenia Pineda, and Zafar Jamil
OBJECTIVES
KEY TERMS
carotid artery stenting | carotid endarterectomy | eversion carotid endarterectomy | restenosis | supra-aortic endovascular treatment
GLOSSARY
arteriotomy a surgical incision through the wall of an artery into the lumen
carotid artery stenting a catheter-based procedure in which a metal mesh tube is deployed into an artery to keep it open following balloon angioplasty to dilate a stenosis
carotid endarterectomy a surgical procedure during which the carotid artery is opened and
The concept of a vascular laboratory has, since its in- ception, revolved around the care of patients who may be candidates for surgery or who have had surgery. The duplex ultrasound evaluation that is conducted on patients who have had a carotid endarterectomy (CEA) should be performed by someone who knows the com- plications of surgery. Now with carotid artery stenting (CAS) becoming mainstream, vascular sonographers must be cognizant of the issues associated with both surgical and endovascular interventions. Differences exist in the procedure and complications that impact the interpretation of duplex testing whether it is per- formed in preprocedure planning, in the immediate postprocedure period, or in long-term follow-up.
This chapter is intended for the vascular sonog- rapher but also presents issues that are important to the vascular surgeon or interventionalist. The clini- cian’s concerns are different for CEA and CAS. It is important for sonographers to recognize that the du- plex data collected post-CAS will not be interpreted
plaque is removed in order to restore normal luminal diameter
in-stent restenosis a narrowing of the lumen of a stent, which causes a stenosis
polytetrafluoroethylene (PTFE) a synthetic graft material used to create grafts and blood vessel patches; a common brand name is Gore-Tex
in the same fashion as for CEA and that the docu- mentation will be different. It is also important to recognize that although CEA procedures are rela- tively stable, CAS is in the midst of its technological refinement. Developments could further impact how the sonographer will perform the duplex examina- tion for either type of patient follow-up.
CAROTID ENDARTERECTOMY
To evaluate the CEA patient either within the first 30 days or in a long-term follow-up, the sonographer needs to be familiar with the operation and the com- plications that can arise during and after the proce- dure. Most surgical procedures have been standard over the years but new modifications are relevant to the practicing vascular sonographer.
The traditional CEA is an open operation that is per- formed through an arteriotomy made longitudinally
Describe the ultrasound protocols unique for carotid scanning in postendarterectomy and poststent patients
Define normal and abnormal criteria associated with carotid stents
List the pathology encountered in a postoperative or postinterventional carotid ultrasound
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