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10 - Carotid, subclavian and vertebral disease

A. Ross Naylor
Leicester Royal Infirmary, UK
Vish Bhattacharya
Queen Elizabeth Hospital
Gerard Stansby
Freeman Hospital
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Key points

  • The extracranial arteries are prone to involvement with a number of important atherosclerotic and non-atherosclerotic conditions

  • The provision of best medical therapy should not be delegated to the most junior member of the team. It is an essential component of care

  • Patients with symptomatic carotid disease benefit from very rapid intervention. Investigative strategies and rapid access to the operating theatre should be geared to ensuring all patients are treated within 2 weeks of suffering their index symptom

  • Relatively few patients with asymptomatic carotid disease benefit from intervention (especially females and patients aged >75 years). It is essential that trials identify high-risk subgroups

  • The role of several technical aspects of carotid surgery has been guided by large randomised trials

  • Patients with symptomatic vertebral stenoses may have a much worse prognosis than was previously thought

Radiation arteritis


Despite the widespread use of radiotherapy in the treatment of head and neck cancers, there is still insufficient data regarding the incidence of symptomatic radiation arteritis.


  • Acute phase: fibrin deposition/endothelial swelling followed by intimal necrosis.

  • Subacute phase: endothelial regeneration with destruction of the internal elastic lamina. Inflammatory cell infiltration of the media and adventitia.

  • Chronic phase: intima becomes thickened with a tendency towards accelerated atherosclerosis. The media and adventitia become progressively fibrotic.

Clinical features

False aneurysm or vessel rupture (acute/subacute phase), stroke due to carotid/vertebral thrombosis, or upper limb ischaemia following subclavian thrombosis (sub-acute phase).

Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 129 - 145
Publisher: Cambridge University Press
Print publication year: 2011

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