THE TECHNIQUE of carotid endarterectomy is now quite standardized. Details vary with the particular case and the particular surgeon. But regardless of the technique used or the surgeon performing the procedure, occasional serious technical problems present themselves when the clamps are removed and flow is reinstituted in the endarterectomized vessel.
The particular problem dealt with in this report is massive bleeding from a "blowout" in the wall of the endarterectomized vessel quite separate from the suture line. This can be due to an actual mechanical perforation of the wall during the endarterectomy. More frequently it is due to a disintegration of an unusually thin vessel wall. At best the remaining vessel is thin, and it is somewhat surprising that this complication is not seen more frequently. Once it is apparent, however, the surgeon's problem is to repair it without ruining the endarterectomy or narrowing the vessel.
A simple closure of