Procedures

Carotid Eversion Endarterectomy and Reconstruction

Eversion endarterectomy of the carotid bifurcation is an alternative to conventional endarterectomy. For this procedure, the ICA is transected at its origin and the plaque is removed as a cylinder by everting the ICA. The ICA is then reanastomosed to the bifurcation, without the use of a patch. In contrast to conventional endarterectomy, a shunt can only be inserted after eversion endarterectomy is completed.

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All Steps in Detail

Step 1: Skin incision and exposure

  1. See conventional endarterectomy

Step 2: Eversion endarterectomy

  1. Slighty oblique transsection of the ICA at ist origin from the bifurcation
  2. Eversion endarterectomy of the ICA
  3. Visual control of the distal end of the endarterectomy
  4. Gentle dilatation of the distal edge by use of vessel bougies (4-5mm)
  5. Optional: shunt insertion from the CCA to the ICA (watch out for air bubbles and avoid distal dissection of the artery by the shunt)
  6. Stay sutures in the ICA
  7. Optional: local endarterectomy of the distal CCA

Step 3: Reconstruction of the bifurcation

  1. Reconstruction of the bifurcation with 5/0 or 6/0 polypropylene running suture
  2. Starting on the side of the assistant, ICA outside-in, CCA inside-out,
  3. Back wall first, stitching direction towards the surgeon
  4. Running suture (parachute technique), no change of the needle necessary
  5. Before completing the running suture: Shunt removal and flushing of the CCA, the ECA and the ICA
  6. Completing the running suture an knotting
  7. Declamping of the ECA first, CCA second and ICA last
  8. Quality control with on table duplex sonography or completion angiography (optional)

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Control of educational objectives (tutor and trainee)

  1. Clear cut arteriotomy, extending beyond the level of the disease proximally and distally
  2. Declamping in correct sequence
  3. No excessive bleeding, narrowing, malrotation or kinking of the reconstruction
  4. Outside aspect: knot tightness, eversion, suture of corners

Pictures and Drawings

Oblique transsection of the ICA at the origin of the birfurcation
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Links and Downloads

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Courses Teaching this Procedure

European Vascular Master Class 2026

Jan 21, 2026
 - 
Jan 23, 2026
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Simulators Used for this Procedure

Carotid Simulator

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About Vascular International

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