The older invasive technique of angiography is still the gold standard for precision, but is seldom used. It can be done under local anesthesia. An incision is made in the carotid bulb and proximal internal carotid. A temporary shunt may be used if a clamp time longer than 10 or 15 minutes is anticipated or if pressure in the distal stump is less than 40-50mm Hg, indicating poor collateral flow.
Some surgeons routinely use shunts, some never.
Distal intimal edges are tacked down if necessary to prevent dissection and secondary occlusion. If the lumen might be compromised by closure, a vein graft patch is used. All rights reserved.