Computed tomographic analysis of airway dimensions after carotid endarterectomy

Airway obstruction is a rare but serious postoperative complication of carotid endarterectomy. We prospectively studied airway dimensions between the hyoid bone and cricoid cartilage in patients undergoing carotid endarterectomy using preoperative and postoperative computed tomographic (CT) scans of the neck. CT scans showed soft tissue swelling in all 19 patients. Five patients with clinical evidence of airway obstruction and a hematoma present on CT scan were intubated postoperatively. The three-dimensional reconstruction of the neck from the CT scans showed a reduction in the volume of the airway in all patients. This reduction was greater in the intubated (62% +/- 9%) compared to the nonintubated (32% +/- 7%) patients (P < 0.01). The anterior-posterior and transverse diameters of the airway were reduced, while retropharyngeal edema was increased after carotid endarterectomy. This change was greater for the upper airway at the level of the hyoid compared to the arytenoids and cricoid, and was significantly greater in the intubated than the nonintubated patients. Tracheal deviation was greater in the intubated than in the nonintubated patients. These results demonstrate significant soft tissue edema of the neck after carotid endarterectomy that reduces airway volume and can result in airway obstruction.