Procedures

Carotid Eversion Endarterectomy and Reconstruction

Carotid eversion endarterectomy is a surgical procedure to remove plaque from the internal carotid artery (ICA) by transecting it at the bifurcation and everting it for plaque removal. The artery is then reconstructed using a fine running suture, with optional shunt use and careful flushing to ensure patency. Final quality control includes duplex sonography and checking for bleeding, narrowing, or kinking to ensure a successful outcome.

All Steps in Detail

Step 1: Skin incision and exposure

  1. See conventional endarterectomy

Step 2: Eversion endarterectomy

  1. Transsection of the ICA at bifurcation level
  2. Eversion endarterectomy of the ICA
  3. Visual control of the distal end of 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 (cave: air bubbles and distal dissection by the shunt!)
  6. Stay sutures in the ICA
  7. Optional: local endarterectomy of the distal CCA

Step 3: Reconstruction of the ICA

  1. Reconstruction of the ICA with running suture 5/0 or 6/0
  2. Starting on the side of the assistance, 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. Shunt removal (optional) and flushing of the CCA, the ECA and the ICA
  6. Quality control with on table duplex sonography (completion angiography optional)

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Control of educational objectives (tutor and trainee)

  1. Clearcut 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 and suture tightness, eversion

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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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