I find that this process is much simpler than in conventional endarterectomy, which requires plication of the proximal ICA prior to patch angioplasty. Figure 1 , Figure 2 , Figure 3 , and Figure 4 graphically outline the techniques used in successful eversion endarterectomy. Figure 1. Figure 2. The eversion endarterectomy technique.
After proximal and distal control have been obtained with atraumatic clamps, the ICA is disconnected from the carotid bulb with an oblique arteriotomy A. The ICA is everted, and the plaque is removed B. The arteriotomy on the CCA is extended proximally C. If the ICA is redundant, it can be shortened. The ICA is reconnected to the carotid bulb with continuous polypropylene sutures E.
Figure 4. In patients with plaque that is isolated to the carotid bulb and very proximal ICA and ECA, the distal CCA can be transected, and proximal and distal eversion can be performed. Many studies have compared standard and eversion techniques for CEA.
The incidence of ipsilateral stroke was 3. The most common complication after CEA is blood pressure instability requiring medical treatment. A recently published meta-analysis reviewed the role of surgical technique in postoperative blood pressure.
There was no difference in the rates of myocardial infarction, stroke, death, or hematoma. Regardless, close blood pressure monitoring in the immediate postoperative period is required, regardless of technique. Eversion CEA is an elegant technique for managing patients with high-grade stenosis of the ICAs and provides excellent long-term stroke prevention for both symptomatic and asymptomatic patients.
There is evidence that the rate of significant restenosis is less than that for patients treated with standard CEA. Foot eversion is when your foot collapses inward, usually with your feet also flattening. The sole of the foot actually faces away from your other foot, increasingly so as the problem worsens. Foot eversion is not particularly common among most people, although our Brookfield foot doctors often see athletes suffering from this type of foot pain. It's also a good idea to know your test results and keep a list of the medicines you take.
Author: Healthwise Staff. Care instructions adapted under license by your healthcare professional. If you have questions about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. If eye perforation is suspected, irrigation should be deferred until formal eye examination can be done. If the cornea may have a deep injury or foreign body, irrigation using a scleral lens may cause further injury and should not be done. Irrigate the eye manually, gently, and very carefully. The cornea or conjunctiva may be mechanically abraded by the tip of the IV tubing, by the scleral lens, or by an irrigating stream pointed directly at the cornea.
Irrigating solution, eg, normal 0. Local anesthetic eg, 0. Patients exposed to chemicals may have other serious chemical burn injuries in addition to ocular burns Ocular Burns Ocular burns can occur after thermal or chemical injuries and can result in serious complications, including permanent blindness.
Ocular burns should be treated simultaneously with treatment of these other serious injuries. Request emergency ophthalmologic consultation for serious ocular burns, especially those involving deep corneal injury, but do not delay irrigation while awaiting the ophthalmologist.
If you are unsure about the severity of a chemical ocular injury, proceed with irrigation of the eye. An assistant may be used to retract the eyelids during irrigation and should stand on the opposite side of the stretcher. Immediate initiation of irrigation is the prime objective when treating chemical ocular burns. Defer other parts of evaluation and treatment, even normally preliminary tasks, including external examination of the eye and rudimentary assessment of visual acuity, until after irrigation.
Whenever possible, check the pH of the eye before irrigation, by touching the lower fornix with a piece of pH paper or the pH strip from a urine dipstick. If pH paper is not immediately available, check pH as soon as possible after beginning irrigation.
Normal pH of the eye as measured with pH paper is about 7. Ask the patient to look upward, and then place a drop of topical ocular anesthetic into the lower fornix of the affected eye. Tell the patient to keep the eye closed until the irrigation begins, in order to retain the drug.
Drops may need to be re-instilled every 5 to 10 min during irrigation. If particulate material may be in the eye and significant chemical exposure is unlikely, sweep potential particulate matter out with a moistened cotton-tipped applicator before irrigation. Sweep both the inferior and superior fornices.
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