Journal «Angiology and Vascular Surgery» • 

2015 • VOLUME 21 • №3

Peculiarities of diagnosis and surgical policy in elderly patients with pathological tortuosity of the internal carotid artery

Kazakov Yu.I.1,2, Pavlov E.V.2, Federyakin D.V.1,2, Ivanova O.V.1,2, Vardak A.1

1) Chair of Cardiovascular Surgery, Tver State Medical Academy of the Ministry of Public Health of the Russian Federation,
2) Department of Heart Surgery №2, Regional Clinical Hospital, Tver, Russia

The study was aimed at optimizing surgical treatment management of elderly patients presenting with pathological tortuosity of the internal carotid artery (ICA). We examined a total of 94 patients with unilateral haemodynamically significant tortuosity of the ICA. Depending on the age, the patients were subdivided into two groups: Group One comprising forty-six (49%) 50-to-60-year-old patients and Group Two consisting of 48 (51%) patients above 60 years (from 61 to 84 years). 37% of patients had were found to have pathological tortuosity combined with haemodynamically significant ICA stenosis. In these patients linear blood velocity in the zone of the largest deformation was by 15% less than in patients with isolated tortuosity (p<0.05). All patients underwent reconstructive operations of carotid arteries with a good clinical effect. A combination of stenosis and pathological tortuosity of the ICA was treated by eversion carotid endarterectomy with lowering down and reimplantation of the artery into the previous ostium; microaneurysms present in the ICA wall were managed by resection of the artery’s portion with autovenous prosthetic repair or bringing down the artery into the previous ostium. In 77% of patients above 60 years the operation was carried out under regional anaesthesia.

According to the findings of duplex scanning, rectilinearity of the ICA after surgery was restored in 100% of cases, blood flow was of major type, with no turbulence registered. It was demonstrated that surgical management of elderly patients with pathological tortuosity is an effective method of prevention of ischaemic stroke. The complications rate in patients presenting with combined atherosclerotic lesions of the ICA and its pathological tortuosity, should adequate surgical policy be employed, falls within the framework of the accepted standards and does not depend on the type of ICA lesion.

KEY WORDS: carotid arteries, pathological tortuosity, stenosis, chronic cerebrovascular insufficiency, surgical treatment, advanced age.

P. 117

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