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Biomedical subjects

R C Darling

Publications and source records attributed to R C Darling.

At least 37 records · Page 2Linked to original sources
PubMed1999

Infrainguinal arterial reconstruction for claudication: is it worth the risk? An analysis of 409 procedures.

PURPOSE: Infrainguinal reconstruction traditionally has been reserved for patients with limb-threatening ischemia. Surgery for debilitating claudication, however, has been discouraged as a result of the perceived fear of bypass graft failure, limb loss, and significant perioperative complications that may be worse than the natural history of the disease. In this study, the results of infrainguinal reconstructions for claudication performed during the past 10 years were evaluated for bypass graft patency, limb loss, and long-term survival rates. METHODS: Data were collected and reviewed from the vascular registry, the office charts, and the hospital records for patients who underwent infrainguinal bypass grafting for claudication. RESULTS: From 1987 to 1997, 409 infrainguinal reconstructions were performed for claudication (9% of all infrainguinal reconstructions in our unit). The patient population had the following demographics: 73% men, 28% with diabetes, 54% smokers, and an average age of 64 years (range, 24 to 91 years). Inflow was from the following arteries: iliac artery/graft, 10%; common femoral artery, 52%; superficial femoral artery, 19%; profunda femoris artery, 16%; and popliteal artery, 2%. The outflow vessels were the following arteries: 165 above-knee popliteal arteries (40%), 150 below-knee popliteal arteries (37%), and 94 tibial vessels (23%). The operative mortality rate was 0%, and one limb was lost in the series from distal embolization. The primary patency rates were 62%, 77%, and 86% for above-knee popliteal artery, below-knee popliteal artery, and tibial vessel reconstructions at 4 years, and the secondary patency rates were 64%, 81%, and 90%, respectively. Cumulative patient survival rates were 93% and 80% at 4 and 6 years as compared with 65% and 52%, respectively, for infrainguinal reconstructions performed for limb salvage. CONCLUSION: Infrainguinal arterial reconstruction for disabling claudication is a safe and durable procedure in selected patients. These data indicate that concern for limb loss, death, and limited life span of the patients with this disease may not be warranted.

Adult↗
PubMed1999

The use of low-dose heparin is safe in carotid endarterectomy and avoids the use of protamine sulfate.

Controversy exists concerning the appropriate dose of heparin needed during carotid endarterectomy. Use of high-dose heparin (100 U/kg) during carotid endarterectomy may require the use of protamine to minimize perioperative bleeding complications. At the authors' institution the use of 30 U/kg heparin for arterial reconstruction has obviated the need for protamine. A retrospective study of carotid endarterectomies performed was undertaken. Patients undergoing combined procedures with carotid endarterectomy were excluded. A total of 420 carotid endarterectomies were performed in 330 patients. All received 3000 U of heparin or less during carotid endarterectomy. Non-fatal stroke and transient neurological deficits occurred in 0.48% and 1.9%, respectively. Mortality was 0.9%. Wounds were dry in 97%, swollen in 2.5% and bloody in 0.5%. No patient received protamine. Two patients were returned to the operating room for re-exploration because of hematoma. In conclusion, the use of protamine may be safely avoided with 30 U/kg heparin, and give acceptable stroke- and minimal complication rates.

Anticoagulants↗
PubMed1999

Outcome after distal vascular reconstruction in women.

Although women are less likely to develop symptomatic atherosclerosis, little data exists on the long-term outcome of women undergoing infrainguinal arterial reconstructions. This study analyzes the operative mortality rate, complications, and the short-term and long-term results after these procedures in both men and women who had symptomatic vascular disease. From 1984 to 1997, 3956 infrainguinal arterial reconstructions were performed at Albany Medical Center. A total of 2474 (62.54%) reconstructions were performed in men and 1482 (37.46%) in women. The mean ages were 67 years for men and 71 years for women. Forty-three percent of the men were smokers compared with 26% of the women. Diabetes was present in 51% of the men and 55% of the women. Claudication was the indication for bypass in 298 (12.05%) men and 110 (7.42%) women. Limb salvage occurred in 2176 (87.95%) men and 1372 (92.58%) women. Perioperative 30-day patency rates were 96.66% in men and 96.50% in women. Primary patency rates at 1, 3, 5, and 10 years were compared; no significant difference existed between men and women. Secondary patency also was similar in both men and women. These results indicate that women requiring arterial reconstruction for infrainguinal occlusive disease had short-term and long-term graft patency results that were comparable with the results of men.

Aged↗
PubMed1999

Outcome of renal artery reconstruction: analysis of 687 procedures.

OBJECTIVE: To evaluate the short- and long-term results of surgical reconstruction of the renal arteries, the authors review their experience with more than 600 reconstructions performed over a 12-year period. SUMMARY BACKGROUND DATA: Reconstruction of the renal arteries, whether for primary renal indications or concomitantly with aortic reconstruction, has evolved over the past 40 years. There is concern that renal artery reconstructions carry significant rates of mortality and morbidity and may fare poorly compared with less-invasive procedures. METHODS: From 1986 to 1998, 687 renal artery reconstructions were performed in 568 patients. Of these, 105 patients had simultaneous bilateral renal artery reconstructions. Fifty-six percent of the patients were male; 11% had diabetes; 35% admitted to smoking at the time of surgery. Mean age was 67 (range, 1 to 92). One hundred fifty-six (23%) were primary procedures and the remainder were adjunctive procedures with aortic reconstructions; 406 were abdominal aortic aneurysms and 125 were aortoiliac occlusive disease. Five hundred procedures were bypasses, 108 were endarterectomies, 72 were reimplantation, and 7 were patch angioplasties. There were 31 surgical deaths (elective and emergent) in the entire group for a mortality rate of 5.5%. Predictors of increased risk of death were patients with aortoiliac occlusive disease and patients undergoing bilateral simultaneous renal artery revascularization. Cause of death was primarily cardiac. Other nonfatal complications included bleeding (nine patients) and wound infection (three patients). There were 9 immediate occlusions (1.3%) and 10 late occlusions (1.5%). Thirty-three patients (4.8%) had temporary worsening of their renal function after surgery. CONCLUSION: Renal artery revascularization is a safe and durable procedure. It can be performed in selected patients for primary renovascular pathology. It can also be an adjunct to aortic reconstruction with acceptable mortality and morbidity rates.

Adolescent↗
PubMed1998

Combined carotid endarterectomy and coronary artery bypass grafting does not increase the risk of perioperative stroke.

Patients who present for coronary artery bypass grafting with hemodynamically significant carotid artery lesions pose a difficult problem for both the cardiac and vascular surgeons. There is no consensus as to the proper management of these patients despite numerous studies. Prospective collection of data was performed in patients undergoing combined carotid endarterectomy and coronary artery bypass grafting's from April 1980 to November 1996. A total of 470 simultaneous carotid endarterectomy's and coronary artery bypass grafting's were performed in 420 patients. The average age of the patient was 69 years, with 62% being male, 15% being diabetic and 38% being smokers. Sixty (13%) presented with Transient ischemic attacks, 22 (5%) presented with amaurosis fugax, 16 (3.4%) presented with a prior history of stroke and 372 (70%) were asymptomatic. Operative mortality was 2.4% or 10 patients; 90% of those patients died from cardiac complications postoperatively and one patient died of a stroke. Permanent neurological deficits occurred in five (1%) of the patients, and six (1.7%) of the patients had a transient neurological deficit that improved prior to discharge. In conclusion, in our experience simultaneous carotid endarterectomy with coronary artery bypass grafting can be performed with an acceptable mortality and morbidity and does not appear to put the patient at a higher risk than when either procedure is performed alone.

Aged↗
PubMed1998

Carotid endarterectomy by eversion technique: its safety and durability.

SUMMARY BACKGROUND DATA: The outcome of standard longitudinal carotid endarterectomy (CEA) can be measured by preservation of neurologic function with a low incidence of restenosis. Closure of the internal carotid arteriotomy with or without a patch may predispose to restenosis. Alternatively, transection of the internal carotid artery at the bulb with eversion endarterectomy allows expeditious removal of the plaque and direct visualization of the endpoint. Because the proximal internal carotid artery is anastomosed to the common carotid artery, this obviates the need for patch closure. The authors report their results with this technique in more than 2200 procedures. METHODS: From May 1993 to March 1998, 1855 patients underwent 2249 CEAs using the eversion technique. During the same period, 410 patients had 474 CEAs by standard technique. Three hundred fifteen procedures in the eversion group and 65 procedures in the standard group were combined CEA and coronary artery bypass grafts. Most solo CEAs (97%) were performed in awake patients using regional anesthesia. Shunts were used on demand in 6% of CEAs. RESULTS: The operative mortality rate was 1.02% (16/1575) in the solo eversion group and 2.2% (9/410) in the standard group. There were 18 permanent neurologic deficits (0.8%) in the eversion group and 11 (2.3%) in the standard group. Transient neurologic deficits occurred in 20 patients (0.9%) in the eversion group and 13 patients (2.7%) in the standard group. Of the 1855 patients, 1786 (96%) presented for duplex ultrasound follow-up. There were seven (0.3%) stenoses greater than 60% in the eversion group versus five (1.1%) in the standard group. CONCLUSIONS: Eversion CEA can be performed safely with a low rate of stroke and death and a minimal restenosis rate in short- and long-term follow-up.

Adult↗
PubMed1997

The performance of femoropopliteal bypasses using polytetrafluoroethylene above the knee versus autogenous vein below the knee.

BACKGROUND: Controversy exists as to the choice of conduit for the treatment of superficial femoral artery occlusive disease, particularly when a patent above-knee popliteal artery exists. Some surgeons advocate the preferential use of polytetrafluoroethylene (PTFE), whereas others favor the use of autogenous vein. This report compares our experience with above-knee femoropopliteal bypass with PTFE versus below-knee femoropopliteal bypass with autogenous vein. METHODS: This study covers a 15-year period extending from 1982 to 1996 during which 1,313 arterial reconstructions were performed for superficial femoral and/or proximal popliteal arterial disease. Four hundred and thirty-eight procedures were performed to the above-knee popliteal artery using PTFE, and 875 procedures were performed to the below-knee popliteal artery using autogenous vein. The indication for surgery was limb salvage in 77% of patients in the PTFE group and 88% of patients in the vein group. RESULTS: The 1-, 3-, and 5-year cumulative life table primary patency rates for the PTFE group were 74%, 56%, and 50%, respectively. The primary patency rates for the vein bypass group were 83%, 75%, and 67%, respectively (P < 0.01). The 5-year cumulative limb salvage rates were 91% and 95% for the PTFE and vein groups, respectively (P = NS). CONCLUSIONS: In this series, below-knee femoropopliteal venous reconstructions have superior patency rates compared with above-knee femoropopliteal PTFE reconstructions. Venous reconstruction for femoropopliteal occlusive disease gives the optimal long-term result. Prosthetic reconstruction should be considered for patients with limited venous conduit or decreased life expectancy.

Adult↗
PubMed1997

Timing of carotid endarterectomy in patients with recent stroke.

BACKGROUND: There is little objective data to support the conventional wisdom of waiting 4 to 6 weeks after stroke to improve surgical outcome of subsequent carotid endarterectomy (CEA). We have aggressively pursued CEA in patients after recent stroke; in this study we report our results. METHODS: We performed 215 CEA procedures in 200 patients who presented with an indication of stroke within 6 months of CEA. Cervical block anesthesia was used 193 cases. The rest were performed with the patient under general anesthesia. RESULTS: Perioperative stroke rate was 1.4% (3/215), and operative mortality was 2% (4/200) (stroke mortality = 3.4%). There were four early occlusions. Shunts were used in 13.9%, patch closure in 8.4%, and eversion endarterectomy in 48% of cases. There was no correlation between timing of surgery, extent of infarct on computed tomography/magnetic resonance imaging, and postoperative neurologic complications with the occurrence of postoperative stroke (p = NS). During the same period, 1,922 patients underwent CEA for indications other than stroke, with a perioperative stroke rate and mortality rate of 1.1%. CONCLUSIONS: Selected patients presenting with a history of stroke and significant carotid artery disease can safely undergo early CEA with a mortality and morbidity comparable to patients undergoing CEA for other indications.

Carotid Stenosis↗
PubMed1997

A prospective randomized study comparing exclusion technique and endoaneurysmorrhaphy for treatment of infrarenal aortic aneurysm.

PURPOSE: The retroperitoneal approach used in aortic replacement for infrarenal aortic aneurysm has become an important part of the vascular surgeon's armamentarium. Use of the exclusion and bypass technique, however, remains controversial. Although benefits may include reduced blood loss, less operative dissection, and a smoother intraoperative and postoperative course, critics of this technique have alluded to potential drawbacks. In this study the results of the exclusion technique and open endoaneurysmorrhaphy for surgical treatment of abdominal aortic aneurysm were compared. METHODS: One hundred patients were randomized to either exclusion (EXC) or open endoaneurysmorrhaphy (OP) procedures. A posterolateral left retroperitoneal approach was used in all patients. During surgery, autotransfusion devices were used when needed. Doppler flow and pressures in the excluded aneurysm sac were determined during surgery in EXC to evaluate the completeness of the exclusion. RESULTS: Patient demographics were similar between the two groups. The mean age was 70 years (range, 53 to 89 years). The operative mortality rates were 0% and 1.9% (1 of 51) in the EXC and OP groups, respectively. Nonfatal postoperative complications occurred in 10.2% (5 of 49) of the EXC group and in 23.5% (12 of 51) of the OP group (p < 0.05). Aneurysm sacs were opened in two EXC procedures. Blood loss (mean +/- SD) was 703 +/- 570 ml in the EXC group and 1031 +/- 703 ml in the OP group (p < or = 0.01). The intensive care unit stay (mean +/- SD) was 1.9 +/- 1.2 days in the EXC group and 3.2 +/- 6.9 days in the OP group (p = NS). The hospital stay (mean +/- SD) was 9.8 +/- 5.8 days and 12.1 +/- 17 days in the EXC and OP groups, respectively (p = NS). There has been persistent flow in the excluded sac in two patients, with sac enlargement in one of these patients on postoperative follow-up by duplex scan or clinical examination. CONCLUSION: The exclusion and bypass technique for repair of infrarenal aortic aneurysm appeared to be an acceptable technique and was associated with less operative blood loss and fewer postoperative complications than those of open aortic endoaneurysmorrhaphy. Exclusion bypass may contribute to a smoother perioperative course and postoperative treatment of these patients.

Aged↗
PubMed1997

Alternative approach for management of infected aortic grafts.

PURPOSE: Prosthetic infection after aortic reconstructive surgery historically has been treated with extraanatomical bypass, graft excision, and aortic stump closure, but at the cost of substantial mortality and amputation rates. Alternatives to this strategy include in situ prosthetic replacement in the infected area, as well as autogenous reconstructions. Inherent to all of these procedures, however, is either the creation of an aortic stump, which carries a significant risk of subsequent blowout, or the placement of a bypass conduit in the infected field, thereby maintaining the potential for subsequent infectious complications. To avoid such problems, we have used retroperitoneal in-line aortic bypass with polytetrafluoroethylene through dean tissue planes. METHODS: Since 1987 we have treated 16 graft infections in this manner. The surgical approach consisted of obtaining retroperitoneal proximal aortic control outside of the infected field (above or below the renal arteries), followed by infrarenal division and oversewing of the distal aorta. A polytetrafluoroethylene bifurcated graft was then sewn to the proximal aorta and tunnelled through the psoas sheath laterally to the profunda femoris artery on the ipsilateral side and via the space of Retzius to the contralateral appropriate femoral vessel, so as to avoid any contact with the infected areas. After the closure of the wounds, a plastic barrier was placed over all incisions and the patient was placed supine. The old infected graft was removed transperitoneally. Extensive cultures were taken at various sites to demonstrate no cross-contamination. RESULTS: All patients were followed-up clinically and with tagged white cell scans at 6-month intervals. There were no immediate postoperative deaths and no amputations. One patient had a myocardial infarction and died at 5 months, and a second patient died at 2 months. Of the remaining 14 patients, none had recurrent sepsis and all have had negative Indium-labeled white cell scans in follow-up. Eleven (78%) are still alive, with a mean follow-up of 32 months (range, 20 to 106 months). CONCLUSIONS: In-line aortic bypass for treatment of aortic graft infections yields excellent results and has become our treatment of choice in dealing with this difficult problem.

Aged↗
PubMed1997

A critical approach for longitudinal clinical trial of stretch PTFE aortic grafts.

Adaptation of new clinical products should be based upon thorough scientific evaluation of properties and performance in vitro and in vivo. Developmental animal research experimentation is classically carried out by the manufacturer with eventual government approval. However, objective data needs to be recorded during clinical trials including handling characteristics, bleeding, tensile strength, kinking, seamline break, dilatation, anastomotic deterioration, patency, and incorporation. Since April 1991, 1010 stretch polytetrafluoroethylene (PTFE) aortic grafts have been implanted at our institution and data were recorded prospectively. Six hundred and seven were for elective abdominal aortic aneurysms, 46 for symptomatic abdominal aortic aneurysms, 58 for ruptured abdominal aortic aneurysms, 17 for elective thoracoabdominal aneurysms, 3 for ruptured thoracoabdominal aneurysms and the remainder were for various aortoiliac pathology. Average age of the patients was 69 (range: 10-95), 66% were males, 25% were diabetics. Overall operative mortality was 5.8% (2.9% in elective cases and 26.6% in emergent cases). There were 23 occlusions; 21 were revised and 2 were replaced with axillofemoral bypasses. Estimated blood loss was 784 cc in elective cases and 1918 cc in emergent cases. Grafts were followed by duplex ultrasound or CT scan every 3 months during the first year and every 6 months thereafter. There were no graft dilatations or false aneurysms in this series. There was one graft infection and no perigraft seromas or anastomotic deteriorations during this follow up. Follow up was complete in 94% of these patients. In conclusion, stretch PTFE graft has acceptable handling characteristics, no excessive bleeding at the suture line and had no anastomotic or graft dilatation. This graft material was suitable for thoracic, visceral, renal and abdominal aortic reconstructions.

Adolescent↗
PubMed1997

Choice of peroneal or dorsalis pedis artery bypass for limb salvage.

BACKGROUND: Arterial reconstructions performed for limb salvage have increasingly used peroneal and dorsalis pedis arteries as outflow vessels. However, there have been few published reports comparing the patency and limb salvage of these alternative outflow tracts. In this report, we have examined our experience with the peroneal and dorsalis pedis artery bypasses for limb salvage. METHODS AND MATERIALS: During a 19-year period, more than 3,500 infrageniculate reconstructions were performed for limb salvage at our institution. Eight hundred and eighty were performed to the peroneal artery and 291 were performed to the dorsalis pedis. Patients' demographics were similar in both groups. Sixty-three percent of patients were male and 52% were diabetic. All surgeries were performed for patients with critical ischemia. In situ technique was used in 68% of peroneal reconstructions and 66% of dorsalis pedis bypasses, respectively. Translocated veins were used in 28% of bypasses and spliced veins were used in 32%. RESULTS: Secondary patency rates to the peroneal reconstructions were 89% and 76% at 1 and 5 years, and 88% and 68% for the dorsalis pedis bypasses, respectively. No statistical difference was found. Sixteen (1.8%) of peroneal artery reconstructions were hemodynamic failures and four (1.4%) were hemodynamic failures in the dorsalis pedis group. Wound complications were observed in 19 (2.2%) of the peroneal group and 7 (2.4%) of the dorsalis pedis group. Limb salvage rates for the peroneal artery are 96% and 93% at 1 and 5 years, respectively, and 95% and 87% for the dorsalis pedis reconstructions, respectively. CONCLUSION: This experience indicates that both peroneal and dorsalis pedis artery reconstructions have acceptable patency and limb salvage rates. Selection of one of these two outflow tracts, when a choice exists, may depend on the conduit limitation and the adjacent tissue infection. However, both outflow tracts are durable and hemodynamically effective for limb salvage.

Arteries↗
PubMed1996

ATP-MgCL2 reduces intestinal permeability during mesenteric ischemia.

ATP-MgCl2 has been demonstrated to have beneficial attributes in numerous models of organ ischemia. In this study we examined whether ATP-MgCl2 could decrease permeability in ischemic segments of rat ileum. Ileal segments (nonischemic and ischemic) from the same rat were cannulated and perfused, and the plasma to lumen clearance of 51Cr-EDTA was measured. Ischemia increased permeability from a baseline value of 0.59 +/- 0.14 (mean +/- SEM in ml/min/g dry wt of intestine) to 1.10 +/- 0.14 at 90 min (n = 12), significantly higher than that of the nonischemic segments (0.55 +/- 0.07) at 90 min (P < 0.05). This was associated with a significant reduction in blood flow from 0.84 +/- 0.08 (n = 4) (mean +/- SEM ml/min/g wet wt of intestine) to 0.16 +/- 0.06 (n = 4) (P < 0.05) as measured by labeled microspheres. Rats receiving ATP-MgCl2 (100 micromol) (n = 8) pretreatment showed no increase in clearance over 90 min (baseline 0.69 +/- 0.07; 90 min 0.70 +/- 0.07) and no significant difference in blood flow from untreated ischemic segments (0.21 +/- 0.9) (n = 4). Tissue ATP levels determined enzymatically were significantly reduced by 5 min postischemia to 4.19 +/- 0.35 (n = 7) (P < 0.05) from a control value of 6.77 +/- 0.77 micromol/g dry wt (n = 14). ATP levels remained depressed at 30 min (3.45 +/- 0.35) and 90 min (3.38 +/- 0.26). ATP-MgCl2 treatment did not significantly alter these tissue ATP levels. These data indicate that ATP-MgCl2 prevents the increase of 51Cr-EDTA permeability during ischemia without alterations in tissue ATP levels or increases in intestinal blood flow.

Adenosine Triphosphate↗
PubMed1996

Beneficial effects of hypertonic mannitol in acute ischemia--reperfusion injuries in humans.

Acute ischemia-reperfusion of extremities is characterized by edema, compartment syndrome and neuromuscular dysfunction. Intravenous hypertonic mannitol has been shown to be of benefit in several experimental models. The authors' 5-year experience with the use of hypertonic mannitol and the treatment of acute ischemia reperfusion injuries in humans has been reviewed. Some of 186 patients with acute arterial occlusion following thromboembolism (149) and trauma (37) were treated. Hypertonic mannitol (25 g intravenous bolus followed by 5-10 g intravenous/h) was given perioperatively. Length of preoperative ischemia varied from 1 to 24h. Some of 57.5% of patients had preoperative neuromuscular dysfunction. Following revascularization, limb salvage was obtained in 97.7% of surviving patients and neuromuscular dysfunction improved in 89%. Overall, 15% required fasciotomy. The mortality rate was 3.2%. These data suggest that hypertonic mannitol may have some protective effect in acute ischemia-reperfusion injuries of human extremities. It may decrease the need for fasciotomy and minimize neuromuscular dysfunction.

Adolescent↗
PubMed1996

Carotid artery bypass in acute postendarterectomy thrombosis.

BACKGROUND: Carotid endarterectomy has demonstrated excellent results over the past 2 decades with combined stroke mortality of < 4% in most active centers. However, the optimal technique for surgical reconstruction for patients with acute postoperative deficits is more controversial. PATIENTS AND METHODS: In the last 10 years (1985 to 1995), we performed 1,267 carotid endarterectomies, with 17 strokes (1.3%) and 16 deaths (1.2%). Twenty-four patients developed acute (within 72 hours) postoperative neurologic deficits. In 10 patients, the carotid artery was confirmed patent by duplex scan or angiography, and the neurologic deficit resolved without further therapy. Early reexploration was performed in 14 cases for suspected thrombosis associated with a new neurologic deficit. In each case, resection of the endarterectomy site and an interposition bypass was performed with greater saphenous vein (11), jugular vein (2), or polytetrafluoroethylene (2) grafts. (One patient required a new bypass for acute occlusion of the initial vein bypass.) Postoperatively, 8 patients had complete resolution of their deficit, 3 had minimal residual deficits, and 3 suffered permanent stroke. However, 2 of these patients died. RESULTS: Carotid artery bypass with exclusion of the endarterectomy site resulted in improvement in symptoms in 79% (11 of 14) of the patients and complete resolution in 57% (8 of 14). In long-term follow up (1 to 41 months), there have been no occlusions and one restenosis requiring revision at 11 months. CONCLUSIONS: Carotid artery bypass can be performed safely with acceptable results. The use of autogenous venous conduits allows reconstruction with an endothelial lined conduit that may improve results in patients with acute postoperative neurologic deficit secondary to thrombosis of the endarterectomized carotid artery.

Acute Disease↗
PubMed1996

Eversion endarterectomy of the internal carotid artery: technique and results in 449 procedures.

BACKGROUND: Preservation of neurological function with a low incidence of restenosis is a measure of the long-term durability of carotid endarterectomy. Routine and selective patch angioplasty of the internal carotid artery have both been used to reduce the incidence of restenosis. The European literature has had many reports of lower restenosis rates in patients undergoing eversion carotid endarterectomy. We evaluated our experience with the eversion carotid endarterectomy procedure over a 2-year period to identify any advantage of this technique. METHODS: Between August 1993 and August 1995, 376 patients underwent 449 carotid endarterectomies (CEAs) using the eversion technique (described below). During the same period, 307 patients underwent 353 CEAs by standard endarterectomy. Demographics were similar in both groups. Fifty-two patients in the eversion group underwent combined open cardiac procedures and carotid endarterectomy. There were 47 such patients in the standard group. Duplex examination was performed after surgery at regular intervals to identify any recurrent stenosis. RESULTS: Operative mortality was 4 of 376 (1.1%) and 6 of 307 (2%) in the eversion and standard groups, respectively. Shunts were used in 15 of 449 patients in the eversion group and 24 of 353 patients in the standard group. Cervical block anesthesia was used in 669 of 687 (97%) of patients undergoing CEA without coronary artery bypass grafting (CABG). There were four permanent neurologic deficits in the eversion group and seven in the standard group, for respective stroke rates of 0.9% and 2%, and there were three transient neurologic deficits in the eversion group and nine in the standard group. There was one (0.2%) restenosis in the eversion group; there were four (1.1%) in the standard group by follow-up duplex scan. CONCLUSIONS: These data demonstrate that eversion carotid endarterectomy can be performed with low stroke and mortality rates in the treatment of extracranial carotid occlusive disease. The incidence of restenosis was lower and approached significance in eversion endarterectomy when compared to standard carotid endarterectomy in the short-term follow-up in this series.

Aged↗