ISSN:
0942-0940
Keywords:
Carotid endarterectomy
;
perioperative complications
;
surgical pitfalls
;
prevention
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary It is estimated that between 1971 and 1987 the number of carotid endarterectomies has increased from 15,000 to over 85,000 per year. Unless the procedure can be performed safely with a combined morbidity and mortality which is below the yearly risk of stroke (5%) for patients with symptomatic carotid artery disease, one should reconsider this operation as a therapeutic option. We review our experience with 891 carotid endarterectomies performed between January 1979 and June 1987. There were 579 (65%) men and 312 (35%) women of ages from 34 to 82 (median 65); risk factors included diabetes mellitus 213 (14%), hypertension 603 (68%), and smoking 630 (70%). Clinical presentation consisted of transient ischemic attacks 506 (57%), cerebral infarction with minimal neurological residual 252 (28%), stroke in evolution 3 (0.3%) and, asymptomatic stenosis 130 (15%). All patients were operated on under endotracheal anesthesia with transoperative monitoring of intra-arterial pressure, central venous pressure and arterial blood gases. Thiopental (3–5 mg/kg) and lidocaine (1 mg/kg) were given for induction and at 15 minute intervals during carotid cross-clamping. Intraluminal shunts were used in 13 (2%). A conventional (open) endarterectomy was performed in 561 (63%) and a limited endarterectomy (closed) in 330 (37%). Complications included 11 (1%) deaths, 26 (3%) developed a major neurological deficit that persisted, 30 (3%) had perioperative TIA's which resolved completely. Of the patients with preoperative neurological deficits, 33 (4%) recovered. Therefore, at one month after surgery, 854 (96%) were either as well or better than preoperatively. Of 514 (58%) postoperative angiograms, 23 (5%) showed an internal carotid artery occlusion; six of them developed an immediate postoperative cerebral infarction and one of them died, Non-neurologic complications were: cardiac 43 (5%), peripheral nerve 33 (3%), and local wound problems 20 (2%). We believe a carotid endarterectomy can be performed safely when it is done with meticulous attention to detail and consistent surgical technique founded on frequent exposure to the procedure.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01424560
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