The retrojugular route: The ideal exposure for carotid endarterectomy performed under locoregional anesthesia

Neri, Eugénio; Giubbolini, M.; Setacci, Francesco; Baldi, Irene; Setacci, Carlo

doi:10.1053/ejvs.2002.1932

Cited by 12 publications

(15 citation statements)

References 4 publications

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“…Awarenesso ft he potential for accessory nerve injury and knowledge of the mechanisms of injury should minimise risk. The few small studies published so far would also support the safety of the retrojugular technique 2,3,14 claiming it to be faster and to have asuperior exposure than the medial approach, particularly at the upper end of the internal carotid, with which we agree.…”

Section: Discussionsupporting

confidence: 65%

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Cranial Nerve Injuries and the Retrojugular Approach in Carotid Endarterectomy

Beasley

Gibbons

2008

annals

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Ann RC oll Surg Engl 2008; 90:6 85-688 685In the 'standard'approach to the carotid bifurcation used in carotid endarterectomy,t he dissection proceeds anteriorly and medial to the internal jugular vein. The facial vein requires division, allowing the jugular vein to be retracted laterally to expose the carotid bifurcation (Fig. 1).The retrojugular approach was originally described to allow dissectionthrough unscarred tissue for re-do surgery or to provide better exposure of the distal internal carotid artery in high lesions. Here, the dissection proceeds behind the internal jugular vein, which is retracted anteriorly and medially to expose the carotid bifurcation. This avoids the facial vein and the small anterior branches of the internal jugular vein at the upper end of the incision (Fig. 2).Recent reports have stimulated ar esurgence of interest in the retrojugular approach, showing it to be safe and possibly faster than the anteromedial approach. 2,3However, concerns have been raised with regard to cranial nerve injury witht he retrojugular approach, 4,5 in particular, whether the accessory nerve may be prone to injury.The aim of this study was to investigate whether the incidence of cranial nerve injuries associated with the retrojugular approach was differentf rom that of the anteromedial approach. Patients and Methods Study designData were obtained from ap rospectively maintained database containing details of 461 carotid endarterectomies performed by or under the supervision of asingle surgeon (CPG) over a1 6-year period and were analysed retrospectively to determine the incidence of cranial nerve injury. PatientsAtotal of 236 (164 males; 72 females; median age, 69 years; range, 43-85 years) primary carotid endarterectomies performed under local anaesthetic using the eversion technique were identified from the database of which 145 were performed via the anteromedial approach and 91 by the retrojugular approach. The choice of approach depended mainly on the date of surgery as the preference of

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Section: Discussionsupporting

confidence: 65%

“…2,3 However, concerns have been raised with regard to cranial nerve injury witht he retrojugular approach, 4,5 in particular, whether the accessory nerve may be prone to injury.…”

mentioning

confidence: 99%

Cranial Nerve Injuries and the Retrojugular Approach in Carotid Endarterectomy

Beasley

Gibbons

2008

annals

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“…1,4,5,[7][8][9] The analysis included 740 CEAs, 333 of which were performed using the retrojugular approach and 407 with the antejugular approach. The reports were published between 2002 and 2009.…”

Section: Resultsmentioning

confidence: 99%

“…Significant heterogeneity in study design was identified. Two studies were randomised controlled trials (RCTs) 5,6 and another three studies were retrospective or prospective observational reports. 1,4,9 A correspondence reporting a brief summary of a single author retrospective experience was included.…”

Section: Resultsmentioning

confidence: 99%

“…3,4 Concerns, however, have been postulated with regard to the high incidence of cranial nerve injury resulting from a different dissection area, especially damage to the accessory nerve and branches of the vagus nerve. [5][6][7][8] The objective of the present study was to conduct a systematic review of the literature and perform a meta-analysis of the outcomes of CEA using the antejugular and retrojugular approach.…”

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confidence: 99%

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Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

Antoniou¹,

Murray²,

Antoniou³

et al. 2014

annals

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INTRODUCTIONThe retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high carotid lesions. Controversial opinion exists with regard to its safety and benefits over the conventional antejugular approach. METHODS A systematic review of electronic information sources was conducted to identify studies comparing outcomes of CEA performed with the retrojugular and antejugular approach. Synthesis of summary statistics was undertaken and fixed or random effects models were applied to combine outcome data. FINDINGS A total of 6 studies reporting on a total of 740 CEAs (retrojugular approach: 333 patients; antejugular approach: 407 patients) entered our meta-analysis models. The retrojugular approach was found to be associated with a higher incidence of laryngeal nerve damage (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 1.46-7.07). No significant differences in the incidence of hypoglossal or accessory nerve damage were identified between the retrojugular and antejugular approach groups (OR: 1.09 and 11.51, 95% CI: 0.31-3.80 and 0.59-225.43). Cranial nerve damage persisting during the follow-up period was similar between the groups (OR: 2.96, 95% CI: 0.79-11.13). Perioperative stroke and mortality rates did not differ in patients treated with the retrojugular or antejugular approach (OR: 1.26 and 1.28, 95% CI: 0.31-5.21 and 0.25-6.50). CONCLUSIONS Currently, there is no conclusive evidence to favour one approach over the other. Proof from a well designed randomised trial would help determine the role and benefits of the retrojugular approach in CEA.

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Scientific surgery

2004

Journal of British Surgery

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The retrojugular route: The ideal exposure for carotid endarterectomy performed under locoregional anesthesia

Abstract: The retrojugular route represents the ideal route for locoregional CEA; this exposure, with respect to the traditional approach, minimizes many of the disadvantages commonly considered as major deterrents of regional anesthesia for carotid surgery.

Cited by 12 publications

References 4 publications

Cranial Nerve Injuries and the Retrojugular Approach in Carotid Endarterectomy

Cranial Nerve Injuries and the Retrojugular Approach in Carotid Endarterectomy

Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

Scientific surgery

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