Single Center Experience With Modified Eversion Carotid Endarterectomy
| Autor: | Albert K. Weyman, Robert B. Patterson, Tze-Woei Tan, Siamak Barkhordarian |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Carotid Artery Diseases
Male Reoperation medicine.medical_specialty Time Factors medicine.medical_treatment Arteriotomy Carotid endarterectomy Single Center Risk Assessment Restenosis Recurrence Risk Factors Occlusion medicine Humans Hospital Mortality Aged Retrospective Studies Endarterectomy Aged 80 and over Endarterectomy Carotid Ultrasonography Doppler Duplex Chi-Square Distribution business.industry Mortality rate Rhode Island Retrospective cohort study General Medicine Middle Aged medicine.disease Surgery Stroke Treatment Outcome Anesthesia Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 25:87-93 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2010.11.004 |
| Popis: | Transaortic endarterectomy is a well-described technique for surgical revascularization of orificial atherosclerotic renovascular disease. Adopting this technique to carotid endarterectomy (CEA), modified eversion carotid endarterectomy (MECE), uses a traditional longitudinal arteriotomy that is confined to the bulb. This obviates the need for patch closure, simplifies the procedure, and permits easy conversion to traditional patch closure carotid endarterectomy (PCEA) for technical defects. We compared the safety and efficacy of this technique with PCEA.Three vascular surgeons performed 223 CEAs between July 2004 and December 2008 at a tertiary teaching hospital. Outcomes measured included perioperative stroke rate, morbidity rate, mortality rate, and late restenosis. The incidence of moderate (60-79%) and severe (≥80%) restenosis was examined at6 weeks, 1 year, and ≥2 years after operation. All patients included in this study underwent follow-up for12 months. Data were analyzed with Student's t-test (p0.05 = significant).CEA was performed for symptomatic disease in 40.4% (90/223) of patients. One surgeon performed MECE in 73.3% (99/135) of his patients during this period; the remaining patients (n = 124) underwent traditional PCEA. Intraoperative completion duplex ultrasound was performed for all patients. In 5.1% (5/99) of the patients, MECE was converted to PCEA for residual flaps. Intraoperative carotid cross-clamping time was significantly shorter in the MECE group (29.2 minutes vs. 52.2 minutes, p0.05). For patients in the PCEA group, the overall mortality rate was 1.8% (4/223), and perioperative stroke rate was 1.4% (3/223). Overall morbidity was 7.2%, which was similar between the two groups. Late restenosis rate on duplex scan was 7.1% (1.0% severe stenosis), early occlusion occurred in one patient with PCEA, and the reintervention rate was 1.0% (2/196). The incidence of late restenosis was similar between the MECE and PCEA group (8.4% vs. 6.2%, p = 0.55). Mean follow-up was 26.3 months for the MECE group and 29.4 months for the PCEA group.MECE is a safer alternative to conventional endarterectomy with a restenosis rate comparable with PCEA, offers the potential advantage of shorter clamping time, and obviates the need for patch closure. |
| Databáze: | OpenAIRE |
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