ABSTRACT
An operation for recurrent stenosis is significantly more difficult than a primary endarterectomy because of the inevitable scarring in the carotid sheath, which distorts the normal anatomy and obscures the usual tissue planes of dissection. I illustrate here an example of recurrent stenosis. The principle in this surgery is to identify the CCA as quickly as possible and dissect up directly over the vessel wall to obtain the requisite exposure. The vascular pickups in this photograph are holding up the tough scar tissue that overlies the common carotid, and one can appreciate the plane underneath this which should be blunt/sharp dissected with the Metzenbaum scissors. The positions of the jugular vein and vagus and hypoglossal nerves may be distorted, and in my experience the best way to avoid damage to adjacent structures is to stay close to the artery and peel all other tissues gently away from it.
