Outcomes of Carotid Endarterectomy with Primary Closure
DOI:
https://doi.org/10.37978/tijfs.v5i2.385Keywords:
Endartrectomy, Primary Closure, OutcomeAbstract
Background: Cerebrovascular ischemic cases are 3rd leading cause of fatality and neurologic dysfunction in adults. Atherosclerotic lesions outside the carotid cranial circulation are main cause of cerebral ischemia in almost 10-20 percent cases and carotid endarterectomy (CEA) has been proved beneficial for patients with severe carotid artery stenosis to prevent acute cerebrovascular events. Current study is conducted to assess the short-term outcomes of carotid endarterectomy among patients in terms of morbidities and mortalities at our institution during the study period.
Material and Methods: This cross-sectional analytical study was carried out at Combined Military Hospital, Rawalpindi during August 2019 to July 2021 to analyze the short-term outcomes of carotid endarterectomy (CEA) with primary closure. All the patients who underwent carotid endarterectomy (CEA) with primary closure during study duration were included in the study. Patients who received selective shunting if Electro Encephalogram (EEG) changes noted were excluded from study. Data was collected after taking verbal consent by using preformed questionnaire. Frequency of morbidities like bleeding, infection, stroke, transient ischemic attacks (TIA), myocardial infarction, repeat operation and revision with stent were noted within postoperative period of one month. Frequency of mortalities in one-month postoperative period among patients undergoing carotid endarterectomy was also calculated. Data was entered and analyzed by using SPSS version 22.
Results: Total 198 patients who underwent carotid endarterectomy with primary closure during study duration were included in the study. Age range of the study participants was between 35 to 80 years. Male patients were 107 (54.04%). The comorbidities evaluated in the study participants showed that 172 (86.87%) patients were hypertensive and 73 (36.87%) has diabetes mellitus. The most frequent postoperative morbidities among patients were bleeding and repeat operation.
Conclusion: It is concluded that carotid endarterectomy with primary closure is a safe and effective surgical means of stroke prevention.
References
Nomani AZ, Nabi S, Badshah M, Ahmed S. Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives. Stroke and Vascular Neurology. 2017 Mar 1;2(1):30-9. doi: 10.1136/svn-2016-000041 DOI: https://doi.org/10.1136/svn-2016-000041
Stavrou M, Perry R, Ioannou A. The role of brain MRI in a patient undergoing carotid endarterectomy after transient ischemic stroke. Archives of Hellenic Medicine/ArheiaEllenikesIatrikes. 2015 Jul 1;32(4). doi: 10.1016/j.avsg.2014.11.018. DOI: https://doi.org/10.1016/j.avsg.2014.11.018
Tai ML, Khoo JK, Elwaifa MA. Extracranial Carotid Atherosclerosis in the Patients with Transient Ischemic Attack. Peripheral Arterial Disease: A Practical Approach. 2018 Oct 17:93. DOI: 10.5772/intechopen.75792 DOI: https://doi.org/10.5772/intechopen.75792
Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Brückmann H, Debus ES, Fiehler J. Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2. International journal of stroke. 2020 Aug;15(6):638-49. doi: 10.1177/1747493019833017. DOI: https://doi.org/10.1177/1747493019833017
Nishigawa K, Fukui T, Takanashi S. Coronary endarterectomy for the diffusely diseased coronary artery. Gen ThoracCardiovasc Surg. 2014; 62: 461-67. doi: 10.1007/s11748-014-0414-x. DOI: https://doi.org/10.1007/s11748-014-0414-x
Bailey CP, May A, Lewman WM. Survival after coronary endarterectomy in man. JAMA. 1957; 164: 641-46. doi: 10.1001/jama.1957.02980060017005. DOI: https://doi.org/10.1001/jama.1957.02980060017005
Effler DB, Groves LK, Sones FM, Shirey EK. Endarterectomy in the treatment of coronary artery disease. J ThoracCardiovasc Surg. 1964; 47: 98-108. doi: 10.1007/s11748-014-0414-x. DOI: https://doi.org/10.1016/S0022-5223(19)33522-6
Wang J, Gu C, Yu W, Gao M, Yu U. Short- and long-term patient outcomes from combined coronary endarterectomy and coronary artery bypass grafting: a meta-analysis of 63,730 patients (PRISMA). Medicine (Baltimore). 2015; 94: e1781. doi: 10.1097/MD.0000000000001781. DOI: https://doi.org/10.1097/MD.0000000000001781
Clagett GP, Patterson CB, Fisher DF Jr, et al. Vein patch versus primary closure for carotid endarterectomy. A randomized prospective study in a selected group of patients. J VascSurg 1989; 9(2):213–223. doi: 10.1067/mva.1989.vs0090213. DOI: https://doi.org/10.1016/0741-5214(89)90040-2
Hertzer NR, Beven EG, O’Hara PJ, Krajewski LP. A prospective study of vein patch angioplasty during carotid endarterectomy. Three year results for 801 patients and 917 operations. Ann Surg 1987; 206(5):628–635. doi: 10.1097/00000658-198711000-00013 DOI: https://doi.org/10.1097/00000658-198711000-00013
Huizing E, Vos CG, van den Akker PJ, Schreve MA, de Borst GJ, Ünlü Ç. A systematic review of patch angioplasty versus primary closure for carotid endarterectomy. Journal of vascular surgery. 2019 Jun 1;69(6):1962-74. doi: 10.1016/j.jvs.2018.10.096. DOI: https://doi.org/10.1016/j.jvs.2018.10.096
Oldham J, Saha S. Carotid endarterectomy: outcome of “old-fashioned” approach. International surgery. 2011 Jan;96(1):60-3. DOI: https://doi.org/10.9738/1338.1
Luebke T, Brunkwall J. Carotid artery stenting versus carotid endarterectomy: updated meta-analysis, metaregression and trial sequential analysis of short-term and intermediate-to long-term outcomes of randomized trials. J Cardiovasc Surg. 2016 Aug 1;57(519):e39. Epub 2016 Feb 17. PMID: 26883249.
Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, Wechsler L, Jaff MR, Gray W. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. New England journal of medicine. 2016 Mar 17;374(11):1011-20. DOI: https://doi.org/10.1056/NEJMoa1515706
Downloads
Published
Issue
Section
License
Copyright (c) 2021 The International Journal of Frontier Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
