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At least 865 records · Page 48Linked to original sources
PubMed1989

Risk factors in a community experience with carotid endarterectomy.

Experience with 1035 carotid endarterectomies in a single community over a 2-year period was analyzed. Twenty-two surgeons working in six hospitals were involved. All surgeons had full-time or part-time appointments at the University of Rochester, 18 had special interest in vascular surgery, and eight had obtained a certificate of qualification in vascular surgery. Mortality rate was 1.4% (14 deaths), with additional permanent, nonfatal, neurologic morbidity of 3.4%. Mortality and morbidity were independent of surgeon, caseload, or hospital. Age and prior history of myocardial infarction influenced the incidence of postoperative myocardial infarction but not the incidence of death or neurologic morbidity. Factors that increased the risk of postoperative death or neurologic complication included hypertension; contralateral carotid disease as manifested by stroke, endarterectomy, or occlusion; whether the patient was a woman; and symptoms of crescendo ischemia. Lack of preoperative neurologic symptoms was correlated with decreased risk of myocardial infarction and neurologic complications. Overall mortality and neurologic morbidity associated with operation for "asymptomatic stenosis" was 3.1% (seven of 222 cases). However, the incidence of contralateral carotid disease was high in the patients in the asymptomatic group (60%), and all complications in this group occurred in patients with prior contralateral carotid endarterectomy or occlusion (p less than 0.05).

Adult↗
PubMed1989

[Endarterectomy of the coronary arteries].

The authors present an account, based on their clinical material, of 15 endarterectomies of the coronary arteries, which from the chronological aspect are divided into two groups. The first six were performed in 1972-1974 without the use of cardioplegia, total cardias arrest, only with ventricular fibrillation, with a 50% rate of success. The series of the remaining nine patients was operated during the period between October 1987 and the end of 1988 under far more favourable conditions, using cold cardioplegia, hypothermia and total cardias arrest. Only one patient died 24 hours after operation, the remaining eight patients are being followed up for one to 14 months after operation. In six patients endarterectomy of the right coronary artery was performed and in three instances in the area of the r. interventricularis of the left coronary artery. There was no case of perioperative myocardial infarction. The immediate postoperative development of the patients is promising and encourages us to proceed with this surgery (endarterectomy of the coronary artery) which is the only alternative method in the group of patients with diffuse distal arteriosclerosis of the coronary arteries.

Coronary Artery Disease↗
PubMed1989

Carotid endarterectomy in patients with intracranial vascular disease: short-term risk and long-term outcome.

To determine the influence of angiographically identifiable intracranial vascular lesions on the outcome of carotid endarterectomy, 597 patients from our carotid surgery registry who had had complete angiographic evaluation were divided into two groups: (1) significant intracranial disease identified by angiography (N = 134) and no significant intracranial disease identified by angiography (N = 463). The short- and long-term outcomes of carotid endarterectomy in the two groups were compared. Perioperative stroke morbidity (intracranial disease 1.9%, no intracranial disease 1.8%) and mortality (intracranial disease 0.5%, no intracranial disease 0.7%) were acceptable and not statistically different (p greater than 0.7). Late stroke prevention was nearly identical in the two groups, with 3-, 5-, and 10-year life-table of stroke-free rates of 93%, 87%, and 79%, respectively, versus 92%, 90%, and 85%, respectively, in the intracranial disease and no intracranial disease groups (p = 0.75). The incidence of recurrent transient ischemic attack was 9.7% in the intracranial disease group and 6.5% in the no intracranial disease group (p = 0.22). In the clinical population studied in the described method, angiographically identifiable intracranial vascular disease did not appear to have a statistically demonstrable influence on the short-term or long-term prognosis after carotid endarterectomy.

Brain Ischemia↗
PubMed1989

Reexploration for thrombosis in carotid endarterectomy.

We reviewed the records of patients undergoing carotid endarterectomy and manifesting either postoperative stroke or thrombosis by oculopneumoplethysmography (OPG-Gee) to analyze the etiology of stroke and to determine the indications for reexploration. Of 900 consecutive elective endarterectomies performed during an 8-year period, 41 patients experienced a perioperative stroke, carotid thrombosis, or both. These patients were subdivided into three groups: group 1, 22 patients with perioperative stroke and carotid thrombosis; group 2, six patients with carotid thrombosis but without symptoms; and group 3, 13 patients with postoperative stroke but no thrombosis. In group 1, 17 patients were reexplored (group 1a), and five were observed without reexploration (group 1b). In group 2, three of the patients were reexplored (group 2a), and the remaining three were observed (group 2b). None of the group 3 patients were reexplored. In group 1a, four (23%) patients awoke from anesthesia with neurological deficits, whereas in group 3, nine (69%) patients awoke with such deficits. Follow-up at 30 days revealed that 76% of group 1a patients demonstrated improvement in symptoms, whereas similar results were seen in only 20% of group 1b patients and 23% of group 3 patients. These trends were maintained throughout the follow-up period of 1-5 years. Those patients who were asymptomatic, group 2, with thrombosis were more likely to have been operated on for asymptomatic carotid stenosis. with thrombosis were more likely to have been operated on for asymptomatic carotid stenosis. Thrombosis was the most common cause of postoperative stroke (63%) in patients after carotid endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[Carotid endarterectomy: long-term ultrasonic evaluation].

Among 128 patients operated for atherosclerosis of the internal carotid artery, 83 (59 males, 24 females, mean age 64 years) were controlled by Doppler ultrasonography, spectral analysis and Duplex. They had been submitted to 86 endarterectomies and 5 operations for total occlusion. In 23 cases, the stenosis was asymptomatic. The delay between operation and control varied between 12 and 123 months (mean follow-up: 50.6 months). 75 patients remained asymptomatic, whereas 8 suffered TIAS. Ultrasound examinations revealed 57 normal arteries or with thickened walls (62.6 p. 100), 9 stenoses less than 50 p. 100 (10 p. 100), 14 stenoses more than 50 p. 100 (15 p. 100) among which 8 were reoperated and 11 occlusions (4 failures of desocclusion and 7 postoperative occlusions: 7.6 p. 100). Recurrent stenoses occurred more frequently in females, mean age lower than in the whole group, as has been already reported. They determined minor symptomatology (vertebro-basilar insufficiency in 2 cases, TIA in 1 case). Three postoperative occlusions were acute and gave rise to a severe neurological deficit, whereas the other ones remained generally asymptomatic. These results are compared to reported series. Ultrasonography is a technique of choice to follow endarterectomised patients. The high rate of recurrent stenoses after endarterectomy raises questions about endarterectomy.

Adult↗
PubMed1988

Accuracy of duplex scanning in the detection of stenosis after carotid endarterectomy.

The results of duplex ultrasonography in grading stenosis after carotid endarterectomy (78 sites) were compared with those of contrast angiography in 71 patients studied for recurrent or contralateral occlusive disease of the carotid bifurcation. Duplex and angiographic studies were performed within one month of each other at a mean postoperative interval of 44 months (range 3 to 122 months). Stenosis of the common carotid (CCA) and internal carotid artery (ICA) was classified into five disease categories (normal or less than 15% diameter reduction [DR], 16% to 49% DR, 50% to 75% DR, greater than 75% DR, and occlusion). The overall accuracy of duplex scanning compared with angiography in predicting recurrent carotid bifurcation disease was 83%, a level of agreement similar to classification of disease involving the nonoperated, contralateral bifurcation (overall accuracy 87%). Recurrent stenosis (greater than 50% DR) or occlusion of the CCA or ICA after endarterectomy was identified with an accuracy of 97%. Overestimation of severity of recurrent stenosis accounted for 11 of 13 duplex classification errors (85%). Presence of moderate (30% to 50% DR) recurrent stenosis of the CCA, tortuosity of the ICA, and severe contralateral carotid bifurcation disease were associated with velocity spectra that predicted a more severe recurrent stenosis at the endarterectomy site compared with angiographic grading. The level of agreement between duplex scanning and angiography was comparable to the interobserver variability in angiographic interpretation. The accuracy reported justifies the use of duplex scanning to grade the severity of carotid bifurcation recurrent stenosis and to follow these lesions for disease progression.

Carotid Artery Diseases↗
PubMed1988

Indications for endarterectomy and STA-MCA shunts in the brain atherosclerosis.

Altogether 169 operations of patients with occlusion or stenosis of the brain arteries and brain magistral arteries are reviewed. In 151 patients the cause of disease was atherosclerosis. No one of the patients has died. According to the thorough investigation consisting of panangiography, dynamic scintigraphy, sonography, ophthalmodynamometry, CT and other clinical investigations, either extra-intra-cranial shunts (STA MCA), or endarterectomies were carried out. The indications for these operations were elaborated with regards to the cause of tandem changes in arteries or to bilateral atherosclerotic changes of the brain arteries. Out of the total 169 operations, 30 endarterectomies were performed. Only two post-surgical complications have appeared, one of them post STA MCA operation and the other after endarterectomy.

Adolescent↗
PubMed1988

Benefit of external carotid endarterectomy in patients with advanced cerebrovascular disease.

The external carotid artery and its branches may serve as critical collateral pathways to the cerebral hemisphere when the internal carotid artery is occluded. In this setting, a stenotic lesion of the external carotid artery can result in hypoperfusion as well as lead to embolic phenomena via enlarged collaterals. This is a report of an experience with six external carotid endarterectomies in five patients from April 1983 to March 1986. All five of the patients had an internal carotid artery occlusion ipsilateral to a significant external carotid artery stenosis. Each patient had symptomatic cerebrovascular insufficiency with four of the five patients demonstrating clear cut symptoms, which lateralized to the side with external carotid stenosis and internal carotid occlusion. These symptoms included amaurosis fugax in four patients and transient extremity weakness in two patients. Four out of five patients were completely relieved of their symptoms after external carotid endarterectomy with follow up periods ranging from 6 months to 2 and one half years. There were no perioperative neurological deficits or complications. The duplex scan was useful in identifying possible candidates for this operation. Important technical details include use of an arterial shunt and closure of the internal carotid artery stump, which may be a source of further emboli. It is concluded that with appropriate patient selection, external carotid endarterectomy can be safely employed with gratifying results in patients with advanced cerebrovascular disease.

Aged↗
PubMed1988

Carotid endarterectomy in a general surgical training program.

Concern regarding the quality of surgical treatment performed within resident training programs and the need for direct, active involvement of the attending surgeon have been issues of interest to surgeons and the public. To provide specialized training in the diagnosis and treatment of vascular disease, vascular surgical fellowships have been established. In institutions with established vascular fellowships, one may question whether general surgical residents or vascular surgical fellows should perform carotid endarterectomies. The majority of carotid reconstructive procedures are performed at our institution by the chief general surgical resident under direct supervision. We elected to review our experience with surgical treatment of the carotid artery in an effort to examine the safety of this practice. The record of all patients who underwent carotid endarterectomy or reconstruction from April 1980 to July 1984 were reviewed. One hundred and twenty-nine patients who underwent 153 reconstructions of the carotid artery constituted the study group. The indication for operation was symptomatic carotid atheromatous disease in 96 and asymptomatic disease in 57. Ninety-three per cent of the procedures were performed by the chief general surgical resident under the supervision of one attending surgeon. Although the incidence of associated systemic problems (hypertension, diabetes and coronary artery disease) was significant in the study group, postoperative cardiovascular and cranial nerve and central neurologic deficits were 1.3 per cent, respectively, with no operative mortality. At our institution, the performance of carotid endarterectomy under close supervision provides an excellent context in which the resident in training may learn precise and careful dissection of the tissue and arterial repair. The need for formal vascular surgical fellowships to develop proficiency in judgment, technique and management of vascular disease is not questioned. However, as a learning experience for the general surgical resident, we believe this practice is both safe and effective, and a high standard of patient care is not compromised.

Carotid Arteries↗
PubMedDate not supplied

Carotid endarterectomy in rats. Technical note.

Carotid endarterectomy in rats. Technical note. Carotid endarterectomy is a widely used surgical procedure for stroke-threatened patients. Thrombosis is a major post-operative risk and appears to occur very early after operation is completed. Several drugs may influence the mechanism of thrombus formation, and theoretically could be considered for perioperative use in clinical cases. Therefore, inexpensive easily reproducible experimental models would be useful. This paper describes microsurgical carotid endarterectomy in the rat.

Animals↗
PubMed1987

Accessory nerve injury during carotid endarterectomy.

Injury to the accessory nerve (cranial nerve XI) during carotid endarterectomy is rare; to date only three cases have been reported in the literature. Traction on the sternocleido-mastoid muscle was the proposed mechanism of injury in all three cases. Four cases of accessory nerve palsy occurred in 850 carotid endarterectomies performed between 1978 and 1986 at this institution, an incidence of 0.47%. All four patients had classic signs and symptoms of accessory nerve injury, which developed between 20 and 60 days after operation. The three most recent cases were examined specifically for accessory nerve injury in the immediate postoperative period and exhibited normal trapezius function. None had any other central nervous system dysfunction. Two of these patients regained full accessory nerve function and the most recent case is showing signs of reinnervation with conservative therapy. Isolated central nervous system and spontaneous accessory nerve palsies are exceptionally rare, and since any traction injury or transection should have been detected by postoperative examinations in three of four patients, we propose surgical scar formation as a mechanism of accessory nerve palsy after carotid endarterectomy. If such a palsy develops in the postoperative period, we recommend conservative therapy.

Accessory Nerve Injuries↗
PubMed1986

Control of hypertension following carotid endarterectomy.

The role of carotid endarterectomy in the treatment of extracranial carotid artery disease has been well established. Postoperative hypertension is a significant prognostic factor and is associated with an increased incidence of both transient and permanent neurologic deficits. We studied 110 patients undergoing unilateral carotid endarterectomy to review the efficacy of the drug combination of hydralazine and propranolol to treat postoperative hypertension. All patients receiving hydralazine and propranolol had their blood pressure controlled postoperatively, and no patients developed hypotension, myocardial infarction, or postoperative neurologic deficits. There were no mortalities in the study group. We conclude that propranolol-hydralazine therapy is a safe and effective means to control hypertension associated with carotid endarterectomy.

Aged↗
PubMed1987

Peripheral nerve injuries during carotid endarterectomy.

Peripheral nerve injuries associated with carotid endarterectomy are fairly common but not emphasized in reported results of carotid endarterectomy. The sensory nerves to the submandibular skin and ear lobe are often damaged. Motor nerves VII, IX, X, XI and XII may be injured at surgery. The commonest motor injuries involve the facial, vagus and hypoglossal nerves. Carotid endarterectomy was studied prospectively over 1 year to document the incidence of nerve injury. Nerve injury occurred in 12% of patients, with facial and vagus nerves being involved in 4% each. Careful surgical technique based on appropriate anatomical knowledge can prevent most of these complications.

Carotid Arteries↗
PubMed1985

Endarterectomy of the left coronary system. Analysis of a 10 year experience.

Between January, 1971, and June, 1981, 278 patients undergoing coronary artery bypass grafting had additional endarterectomy to the left coronary system. This constitutes 28% of all patients undergoing bypass grafting. Additional endarterectomy of the left anterior descending was performed in 250 and of the circumflex in 75 (an average of 1.2 endarterectomies to the left coronary system per patient). Five hundred thirty-six additional grafts to other vessels were performed, for a total of 861 grafts (three grafts per patient). There were 11 (4%) early and 29 (10%) late deaths. The actuarial survival rate was 93% at 3 years and 80% at 6 years. The incidence of perioperative myocardial infarction was 12%. Of the survivors, 94% were either asymptomatic or improved. Two hundred forty-three grafts (75%) were restudied early (2 weeks to 1 year). The early patency rate of the grafts to the left anterior descending was 83% (156/188) and to the circumflex 75% (41/55). In 75 patients (81 grafts), restudied 1 year or more after operation, the patency rate was 75% (61/81). The runoff of grafts to the left coronary system was judged to be good in 76%, moderate in 14%, and poor in 10%.

Adult↗
PubMed1985

The post endarterectomy carotid bruit. Evaluation by Duplex scan.

The presence of a bruit after carotid endarterectomy may indicate a persistent or recurrent lesion. The authors noninvasively evaluated, by Duplex scanning, 18 asymptomatic postoperative patients who underwent a total of 23 carotid endarterectomies and who developed a postoperative bruit to determine the significance of the bruit. Eleven men and seven women were studied from 6 weeks to 2 years postsurgery. Ages ranged from 49 to 75 years (63.6 +/- 8.0 years). Indications for endarterectomy were: transient ischemic attacks (including amaurosis fugax), 17 vessels; completed stroke with significant functional recovery and residual carotid disease, 3 vessels; and asymptomatic bruit with hemodynamically significant carotid stenosis, 3 vessels. Each patient had a Duplex scan performed to noninvasively evaluate the carotid artery. All scans were independently reviewed by two observers. Real-time B images were interpreted as normal in 14 vessels, mild thickening in eight vessels, and moderate thickening in only one vessel. Doppler recordings demonstrated a spectral range of 15-40 cm/sec (26 +/- 8 cm/sec). Ratio of velocity in the internal carotid artery to common carotid artery (VIC/VCC) ranged from 0.389 to 1.281 (0.779 +/- 0.250). This study demonstrates that the presence of a postoperative carotid bruit does not necessarily signify the presence of residual carotid disease or a hemodynamically significant lesion.

Aged↗
PubMedDate not supplied

The effect of unilateral carotid endarterectomy on neuropsychological test performance in 53 patients.

Six psychomotor tests (Ravens matrices, finger tapping, spatial orientation, arithmetic, vocabulary, and short-term memory) were administered preoperatively, at 3-7 days and 3 months postoperatively to 53 patients undergoing unilateral carotid endarterectomy between 1978 and 1982. Standard operative technique included general anesthesia and Javid shunt. None of the patients experienced postoperative neurological deficit or significant complications. Individual and cumulative test scores were correlated with prior CVA, neurological examination, cerebral angiography, pre and postoperative computerized cerebral tomograms and intraoperative carotid flow measurements. Psychometric scores did not change postoperatively in 18 patients with prior CVA's. Forty-five patients operated upon for high grade stenosis (75% reduction in cross sectional diameter) had a significant increase in early post-endarterectomy test scores which returned to preoperative levels by three months postoperatively. Increase in intra-operative carotid artery blood flow correlated with improved test performance. We conclude that carotid endarterectomy of flow restrictive stenosis initially augments psychometric test performance but the improvement is not sustained at the third postoperative month.

Endarterectomy↗
PubMed1985

Oscillating loop endarterectomy for peripheral vascular reconstruction.

A new technique for endarterectomy of the aorta, iliac, femoropopliteal, and three distal vessels of the lower leg is a safe and predictable method of endarterectomy that has proved to be effective. By the use of this technique the superficial femoral artery and its collateral branches are opened, considerably increasing the blood flow to the lower leg. Increased knowledge concerning thrombogenic enzymes, released when cleavage of the arterial wall is performed, has led to the use of antiplatelet and anticoagulative drug therapy. This has significantly enhanced the patency of the endarterectomized vessel. Today, with many patients having the saphenous veins harvested for coronary bypass or needing these veins for future bypass surgery, it seems reasonable to perform an endarterectomy of the femoral artery.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Simultaneous bilateral carotid endarterectomy operations.

Clinical reasoning and sound physiologic data have been the bases for performing bilateral simultaneous carotid endarterectomy operations in 25 patients recently. The results have compared favorably with unilateral carotid endarterectomy operations in 100 patients over the same time span. Thus, there is ample basis for performing operations simultaneously when bilateral carotid endarterectomy operations are indicated.

Adult↗