Arkadiusz Kazimierczak, Anita Rybicka, Paweł Szumiłowicz, Piotr Gutowski, Halina Kupicz, Rabih Samad, Tomasz Zakrzewski, Marcin Śledź


Introduction: Minimally invasive procedures in carotid endarterectomy are currently preferred. Smaller skin incisions (transverse or longitudinal) and the mapping of carotid artery bifurcation with Doppler ultrasound are promoted. There is a lack of papers about cosmetic effects and patients’ preferences. The aim of this study was to qualify natural skin wrinkles as potential anatomical markers of carotid artery bifurcation and scar camouflage.

Material and methods: 50 patients underwent carotid endarterectomy in 2013–2014 in the Vascular Surgery Department of the Pomeranian Medical University in Szczecin. The positions of wrinkles were compared with the anatomical location of carotid artery bifurcation with the use of Doppler – Duplex Ultrasound. Patients’ preferences and cosmetic effect were also assessed.

Results: 50% of patients declared the cosmetic effect important. Nevertheless, every patient preferred a transverse incision along a wrinkle line. The wound scar was invisible in 76% of cases 3–6 months after surgery. Wrinkles were close, within 1 centimeter, to carotid artery bifurcation in 80% of cases. It was mainly 4–5 cm from the angle of the mandible. Surgical access along wrinkles located 3, 4, 5, 6, 7 cm from the gonial angle was technically easy in 55%, 77%, 79%, 45%, and 21% of cases, respectively. Using ultrasound before surgery allows the planning of the optimal incision in 98% of cases.

Conclusions: Transverse incision hidden in the wrinkles of the neck gives a good cosmetic effect and allows carotid endarterectomy in every case when carotid artery bifurcation is marked prior to surgery.


carotid endarterectomy; minimally invasive surgery; USG guided mapping

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Liapis C.D., Bell P.R.F., Mikhailidis D., Sivenius J., Nicolaides A., Fernandes J. et al.: ESVS Guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009, 37, 1–19.

Ascher E., Hingorani A., Marks N., Schutzer R.W., Mutyala M., Nahata S. et al.: Mini skin incision for carotid endarterectomy (CEA): a new and safe alternative to the standard approach. J Vasc Surg. 2005, 42 (6), 1089–1093.

De Troia A., Mosso F., Biasi L., Corona P., Tecchio T., Azzarone M. et al.: Carotid endarterectomy with mini-invasive access in locoregional anaesthesia. Acta Biomed. 2008, 79, 123–127.

Marcucci G., Antonelli R., Gabrielli R., Accrocca F., Giordano A.G., Siani A.: Short longitudinal versus transverse skin incision for carotid endarterectomy: impact on cranial and cervical nerve injuries and esthetic outcome. J Cardiovasc Surg (Torino). 2011, 52 (2), 145–152.

Langer K.: On the anatomy and physiology of the skin. Br J Plast Surg. 1978, 31 (1), 3–8.

Bartolucci R., D’Andrea V., Leo E., De Antoni E.: Cranial and neck nerve injuries following carotid endarterectomy intervention. Review of the literature. Chir Ital. 2001, 53 (1), 73–80.

Jayasooriya G.S., Shalhoub J., Thapar A., Davies A.H.: Patient preference survey in the management of asymptomatic carotid stenosis. J Vasc Surg. 2011, 53 (6), 1466–1472.


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