“Learning eversion carotid endarterectomy under cervical plexus block anaesthesia has changed our practice”

Veronika Palmiste

By Veronika Palmiste and Vladislav Fedossov

We attended the training course on eversion carotid endarterectomy under cervical plexus block anaesthesia organised by the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre from 13–18 May 2012. This was the second year of the course. It was oriented to vascular surgeons and anaesthesiologists who treat patients with carotid stenosis in low volume centres and who are interested in operating the carotids under cervical plexus block.

Our centre is relatively new in the Estonian vascular surgery and that is why our numbers are small – 20 carotid operations per year by one surgeon. Our method of choice for treating carotids is eversion endartherectomy under cervical plexus block anaesthesia. The main reason why we wanted to participate in that workshop was to perform carotid surgery faster and to learn some tricks and tips on anaesthesiological preparation.

The course was held as the programme promised – operations in the morning and discussions in the afternoon. There were six surgeons and one anaesthesiologist who attended the course. It was also possible to attend the emergency work during those five days and we did not miss the opportunity.


By the end of the workshop, 30 carotid operations had been performed in five days, which is a impressive number for any centre. And as it goes with the carotid surgery, you never know what the exact course of the operation is going to be. It means we saw not only nicely removable plaques from internal carotid arteries and quickly done eversions, but situations when there was the need for  temporary shunt, patch angioplasty or grafting of the internal carotid artery. Not less important was the teamwork between surgeons and anaesthesiologists, which at the end of the day saved lives.

It is our pleasure to recommend participating in future workshops on carotid surgery held at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre. We think it might be of special interest to those specialists who perform 20–30 carotid operations annually and who still have questions about the benefits and safety of cervical plexus block anaesthesia. We recommend that you go as a team of surgeon and anaesthesiologist.  It will definitely promote cooperation in the team and make you more efficient. Having seen how fast they are in Belgrade performing the whole operation, we are quite sure that the future participants will be at least tempted to use the eversion technique instead of conventional endarterectomy in carotid surgery.

We thank Prof L Davidovic and his team very much for organising something so useful for the rest of us. Special thanks to Dr I Koncar for the kind reception and for letting us know about the course – it has definitely changed our practice!

Veronika Palmiste, is vascular surgeon, and Vladislav Fedossov, anaesthesiologist, are with the East Tallinn Central Hospital, Estonia