The technique of eversion carotid endarterectomy.

Eversion endarterectomy of the Internal Carotid Artery (ICA) has been employed as a good alternative method to classical carotid endarterectomy. The details of this technique are presented. The main operative steps are: complete transection of the ICA from the carotid bifurcation, eversion endarterectomy of the ICA, endarterectomy of the External Carotid Artery, reimplantation of a the ICA to its normal position and reconstruction of a new bifurcation. The major advantages of this attractive technique are optimum correction of an elongated ICA in combination with stenosis, avoidance of patch material for arteriotomy closure and low restenosis rate.

Experience with the use of uncuffed double-lumen silicone hemodialysis catheters.

AIM: This study aimed to describe our experience with the use of uncuffed double-lumen silicone hemodialysis catheters (USHDCs) that were used in 54 cases as a temporary vascular access (VA). SUBJECTS AND METHODS: We recorded, retrospectively, all the USHDCs (size 13.5 French (F), length 15, 20 and 24 cm) that were inserted in our dialysis unit from July 2003 to September 2004. Catheter and patient characteristics, as well as catheter related complications, were recorded. RESULTS: There were 88 catheters used in 54 cases (44 patients). The catheters remained in place for a total of 2537 days (range 8-127 days, mean 46.9 +/- 31.1). For catheter placement, the internal jugular veins (group A) or the femoral veins (group B) were used in a non-randomized manner. In group A, in 17 cases, 31 catheters were used for a total of 1169 days (mean 68.7 +/- 28.5), while in group B, in 37 cases, 57 catheters were used for a total of 1368 days (mean 36.9 +/- 27.1; p < 0.001). In group B, 81% of cases (30/37) were ambulatory from the time of insertion. Mean urea reduction ratio (URR) in well functioning catheters (blood flow > or = 200 ml/min) was 65.5 +/- 4.6% in group A and 56.9 +/- 6.2% in group B; p < 0.001. Catheter-related bacteremia was observed in five group A cases and in seven group B cases (p = ns). Three cases of minor bleeding at the insertion site and three cases of ipsilateral leg edema were recorded in group B patients. In group A, only one case of bleeding at the insertion site was recorded. CONCLUSION: Uncuffed double-lumen silicone hemodialysis catheters (USHDCs), 13.5 F in size, provided a very efficient temporary VA when placed in the jugular vein. Femoral placement of these catheters can also be used successfully in non bed-ridden patients, but delivering a lower dialysis dose.