Retrojugular approach for carotid endarterectomy – experience in 536 patients

Carotid endarterectomy is conventionally performed through an approach medial and anterior to the jugular vein, mobilization of the ansa cervicalis and dissection of the hypoglossal nerve. We describe the technique, and the results in a cohort of 536 patients of the retrojugular approach. From July 2002 to July 2005 715 carotid endarterectomies were performed for stenosis >70%, meanage was 67.2 years. 536 of these patients underwent the endarterectomy by the retrojugular approach. All operations were performed in general anaesthesia and by using shunt and patch closure. No patient died intra or perioperatively. We found 4 cerebral neurological events (0.7%), two of them persistent and the other transient. 4 lesions of the accessorius nerve (0.7%) and one thrombosis of the jugular vein. The surgical approach to the carotid bifurcation has traditionally been anterior with division of the facial vein and the branches of the jugular vein. In presence of high bifurcation the retrojugular approach appears safer because no dissection of the hypoglossal nerve is necessary. Our experience of 536 patients operated on carotid stenosis by the retrojugular approach shows, that the access and rapidity of the exposure by this approach is superior to the conventional antejugular approach.