- Develop a “step-by-step” guide to perform an appropriate Vascular Ultrasound evaluation protocol of the Carotid arteries afterendarterectomy. - Illustrate the main normal and pathological findings.

Carotid endarterectomy is a revascularization technic whose main objective is to prevent new ischemic brain episodes in patients with an established risk. The NASCET study published in 1991, has shown that symptomatic patients with >70% carotid stenosis, will benefit from a surgical treatment (endarterectomy vs medical treatment), with a smaller stroke recurrence rate. Since then, there will be 29 years now, that endarterectomy is been performed. Duplex Ultrasound is one of the most useful methods to do follow-up, because it is non-invasive, with good sensitivity...

1. UNDERSTANDING CAROTID ENDARTERECTOMY Endarterectomy (CEA) is an open surgery, in which the Carotid arteries are sectioned longitudinally to exposethe arterial lumen, and from inside, remove the intimal layer of the arterial wall along with atheromatous plaque. The arteriotomy is closed after that, by simple suture, or also using a venous (autogenous) or synthetic patch (Dacron, PTFE), to widen the lumen. After the procedure, three main obstructive problems can arise: 1) narrowing of the lumen, 2) peristance of residual plaque or 3) neointimal hyperplasia. 2....

CEA remains the traditional approach toward treating carotid bifurcation lesions. Vascular ultrasound is the method of choice for the control and monitoring of patients operated for CEA. It is important for the sonographer to learn how to recognize normal findings,to know how to explorethe intimalshelves of the CEAsite and take into account the possible complications to be able to classify the observed findings.

J. Crosta. Chief of Ultrasound area. Mail: [email protected] H. F. Varela P. Tarraga Tolaba A. M. Perdomo Olivera J. A. Palacios Cuesta N. H. C. P. Cussa Naizir All of the above are Radiology residents in training Y. P. Narváez Rojas Radiology Resident´s Instructor L. Borrino Head of Radiology department F. Abramzon Forme Head of Radiology department Hospital de trauma y emergencias Federico Abete. Pablo Nogués. Malvinas Argentinas. Buenos Aires. Argentina- nothing to disclose

1- Kupinsky AnnMarie. The Vascular System. Diagnostic Medical Sonography. Wolters Kluwer. 2018. Second edition. 2- Zierler R.Eugene. Strandness¨s Duplex Scanning in Vascular Disorders. Wolters Kluer. Lippincott Williams & Wilkins. 2010. Fourth edition. 3- Pellerito John, Polak Joseph. Introduction to Vascular Ultrasonography. Elsevier Saunders. 2012. 6th edition. 4- AbuRahmaAF et al. Proposed duplex velocity criteria for carotis restenosis following Carotid Endarterectomy with patch closure. JVascSurg.2009;50: 286-291. 5- AbuRahmaAF et al. The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after Carotid endarterectomy. JVascSur.2015;...