Carotid endarterectomy: nursing care and controversies.

Carotid endarterectomy, was first performed in 1951 and has since become one of the most commonly recommended operations. However, it has recently come under scrutiny for being performed too frequently for the wrong indications and at too high a risk for the patient. This article will cover pertinent anatomy and physiology of cerebral blood flow, symptoms of carotid circulation ischemia, indications for surgery along with the expected risks and benefits, and the role neuroscience nurses play in the care of these patients. In order to assist neuroscience nurses in ethical decision making regarding patient advocacy, several controversies surrounding carotid endarterectomy will be addressed.

Detachable balloon occlusion of carotid-cavernous sinus fistula.

A carotid-cavernous sinus fistula, an abnormal communication between the carotid artery and the cavernous sinus, may develop as a result of trauma or spontaneously. The goal of treatment is to occlude the fistula while preserving blood flow in the carotid artery. Intravascular embolization by means of a detachable balloon achieves both these goals without craniotomy. Clinical signs, diagnosis, treatment, and a nursing care plan for patients with carotid-cavernous sinus fistula are presented. Two case studies along with nursing interventions are described.

Carotid endarterectomy: a review.

The carotid endarterectomy procedure has provided an invaluable option in the management of patients with symptomatic atherosclerotic carotid artery disease. The criteria for surgical interventions vary from different institutions as well as the mortality and morbidity, but, for a select patient population, it is a viable alternative to conservative medical management.

Subclavian-external carotid artery bypass graft. Restoring blood flow to the brain.

This article describes an unusual surgery for a type of carotid artery disease. The perioperative nurse has an important role on the vascular team when performing this procedure. For this reason, a thorough knowledge of the events and possible complications are important in the care of these patients. Careful preoperative nursing assessment and postoperative follow-up will help prevent any complications and promote a successful outcome in these patients.

Carotid artery aneurysm: a case study.

Carotid artery aneurysms are rare. Nurses need an awareness of these lesions in order to conduct appropriate neurological and cardiovascular assessments, provide appropriate preoperative and postoperative interventions and educate patients and their families. Understanding carotid artery aneurysms enables the nurse to provide quality nursing care to this patient population.

Carotid fistula.

Frequently it is the ophthalmic nurse who obtains the patient's pertinent health history and background information. This case study of a patient diagnosed with an orbital carotid fistula shows how the nursing history helped to solve the patient's diagnosis.

Clinical guidelines: grading the evidence behind the practice.

Clinical practice guidelines are statements to assist in healthcare decisions for patients with the same illness or procedure. Guidelines comprise elements that describe different aspects of the patient's condition and the required care. Many organizations publish guidelines, including the Society for Vascular Nursing. Evidence is the foundation of guidelines and their practice recommendations. This evidence is primarily from research. Developing a grading system for the research and the associated practice elements improves the strength of a guideline's statements. This article discusses the grading system selected by the Society for Vascular Nursing (SVN) Practice and Research Committee when creating the forthcoming carotid stent nursing practice guideline.