The carotid artery and upper limb vascular diseases

26 The carotid artery and upper limb vascular diseases





Questions



image How may carotid artery disease present?

image What are the indications for surgery in carotid artery disease?

image What is Raynaud’s phenomenon?



Carotid artery disease


Disease of the carotid arteries is a common cause of stroke. It is caused by atherosclerosis of the carotid artery, most commonly at its bifurcation (Fig. 3.26.1).


image

Fig. 3.26.1 Carotid artery disease. (A) Stenosis of the carotid artery from atheroma and an associated thrombus; (B) stenosis can lead to clots breaking off from the thrombus; (C) symptoms. TIA, transient ischaemic attack.



Pathology


Atherosclerosis occurs most commonly at the carotid artery bifurcation. A subsequent embolism from the plaque (atheroma) leads to carotid territory ischaemia. Global ischaemia caused by hypoperfusion may occur if there is severe bilateral carotid stenosis and disease of the vertebral arteries.



Clinical features


Main features are shown in Fig. 3.26.1B, C.



Investigations


Initial investigations are blood pressure, glucose, cholesterol, cross-match for blood. This is followed by duplex scan to show degree of stenosis, angiography (confirms duplex findings and defines arterial anatomy) and CT/MRI (identifies cerebral infarcts).



Management



Conservative and medical management


This approach is suitable for asymptomatic patients with less than 70% stenosis: stop smoking, take aspirin and statin and control hypertension.



Surgical management


Carotid endarterectomy is used for stenosis > 70% and for symptomatic disease with any degree of stenosis. The carotid artery is opened and thrombus and diseased intima removed (often using a temporary shunt to bypass the operative field and maintain cerebral perfusion). A patch graft (e.g. from a forearm vein) is placed. Stroke and mortality rate should be < 5%. The risk of stroke with surgery and best medical therapy is considerably less than with best medical therapy alone.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on The carotid artery and upper limb vascular diseases

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