Intraoperative color-flow duplex ultrasonography following carotid endarterectomy.

Intraoperative color-flow duplex ultrasonography represents the state-of-the-art imaging following carotid endarterectomy. At a reasonable cost and at no risk to the patient, it provides a high-resolution image of the operative site and reproducible hemodynamic velocity measurements. Although significant technical abnormalities have been noted in approximately 10% of patients, important lesions are found in only 5% of common or internal carotid arteries. In our opinion, these common and internal carotid artery defects represent the lesions that should be re-explored and corrected prior to leaving the operating room. The most cost-effective way to utilize intraoperative color-flow duplex ultrasonography is to arrange a 15- to 20-minute visit to the operating room by a technologist bringing a duplex scanner from the vascular laboratory or department of radiology. If the surgeon is not experienced in performing duplex ultrasonography, the test should be performed in conjunction with another physician, surgeon, or radiologist who specializes in ultrasound. In our experience, color-flow duplex ultrasonography enhances endarterectomy technique and consequently minimizes postoperative strokes and restenosis.