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At least 1,513 records · Page 84Linked to original sources
PubMed1985

Local anesthesia in carotid endarterectomy: an alternative method.

Results of carotid endarterectomy (41 operations) carried out under local anesthesia are presented. There were no deaths within 30 days. Three patients had undergone surgery with a temporary internal shunt, following signs of neurological changes (unconsciousness, aphasia, motor changes) during 1-min test cross-clamping. No neurologic deficits were observed, and only two patients (4.8%) experienced postoperative hypertension. These data support the view that simple neurological monitoring of awake patients enables accurate assessment of the need for an internal carotid shunt. Carotid endarterectomy under local anesthesia seems to be a very safe procedure. Use of this technique is especially appropriate for elderly patients with hypertension and ischemic heart disease.

Aged↗
PubMed1985

[Severe ischemia caused by femoro-popliteal thrombosis. Endarterectomy using a pneumatic oscillator].

Autologous saphenous vein bypass is the best treatment for severe ischemia with femoro-popliteal thrombosis. But in over 20% of cases a vein is not available. Patency rates after prosthetic grafts are low. Therefore we have tested femoro-popliteal endarterectomy with the Hall arterial oscillator. This instrument is composed of loops (size: 5-12 mm) and of a pneumatic oscillator. All the length of the artery has to be exposed. The endarterectomy is started with a spatula and is then performed with the oscillating loops. Three arteriotomies are usually necessary to remove the total core. After the arterial vacuity has been checked, the distal intima is tacked down and the arteriotomies are closed with or without a venous patch angioplasty. Thirteen patients have been operated on. All of them were high risk patients. They were submitted to surgery for rest pain, distal gangrene or acute ischemia. During the post-operative period, one death and 4 thromboses occurred, the latter leading to major amputation with two subsequent deaths. Early results of the 8 other patients were good. Mean follow-up was ten months. Limb salvage was achieved in 7 patients out of 8,6 of them with patent artery and 1 with an occluded artery. Run off was an essential condition for patency. The best results were achieved when distal arteries were patent. But some success occurred in spite of a poor run off. This technic is an useful and money saving alternative for severe ischemia associated with femoro-popliteal thrombosis when autologous vein is not available.

Aged↗
PubMed1985

Optimal cerebral monitoring during carotid endarterectomy: neurologic response under local anesthesia.

A prospective series of carotid endarterectomies were performed with patients given local anesthesia in an attempt to determine the efficacy of intraoperative EEG monitoring and/or stump pressure measurements in predicting the need for carotid shunting. Carotid artery stump pressure was measured and EEG changes noted; however, neither low stump pressure nor EEG changes influenced the decision for shunt insertion. A shunt was only used if a neurologic deficit developed during carotid clamping. A total of 134 carotid endarterectomies were done in 121 patients. Sixty-six patients were men and 55 were women with ages ranging from 41 to 88 years. Indications included transient ischemic attacks in 57 (43%), prior stroke in 25 (19%), vertebrobasilar symptoms in nine (6%), and asymptomatic patients with high-grade stenosis, 43 (32%). Thirteen patients (9.7%) developed neurologic deficits following carotid clamping and had shunts inserted. All deficits cleared following shunt insertion. Nine of the 13 had EEG changes, but in four, EEGs were unchanged despite the occurrence of clear-cut neurologic changes. Stump pressure in the 13 patients ranged from 14 to 78 mm Hg. Ten were greater than 24 mm Hg and three were more than 50 mm Hg. In 121 operations no neurologic deficits occurred during carotid clamping and no shunts were inserted. In 13 of these operations, significant EEG changes were noted. Stump pressures in these 13 with EEG changes ranged from 15 to 120 mm Hg. In seven, stump pressure was greater than 50 mm Hg. There were no deaths in the series. Two (1.5%) temporary and one (0.7%) permanent postoperative deficits occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Myocardial infarction following carotid endarterectomy: a review of 683 operations.

In a series of 683 consecutive carotid endarterectomies, there were 16 postoperative myocardial infarctions which resulted in five deaths. Of 399 operations on patients with no previous history of heart disease, there were only two myocardial infarctions (0.5%). Two hundred and eighty-four operations were performed on patients with heart disease, and vasopressors were administered in 135 of these procedures. For these patients the risk of myocardial infarction increased from 2.0% to 8.1% with the use of vasopressors (P less than 0.001). The management of the patient with stable heart disease undergoing carotid endarterectomy is discussed.

Carotid Artery Diseases↗
PubMed1979

Carotid endarterectomy in a community hospital.

One hundred consecutive patients underwent carotid endarterectomy in a small community hospital in North Dakota during a period between 1969 through 1976. All operative procedures were performed by the same surgeon using the Javid shunt. A 1 per cent operative mortality and permanent morbidity resulted. These findings are comparable with those reported from large medical centers having extensive experience in carotid endarterectomy. It is concluded that patients with carotid artery disease can be safely and effectively treated in small medical centers by well trained experienced vascular surgeons.

Adult↗
PubMed1978

Routine operative arteriography during carotid endarterectomy: a reassessment.

One hundred and thirty-one consecutive operative arteriograms done in conjunction with carotid endarterectomy are reported. Radiographically obtrusive defects were found in 5.3% of arteriograms, with 1.5% in the common carotid artery, 2.3% in the external carotid artery, and 1.5% in the internal carotid artery. Potential complications were introduced by the operative arteriograms in 2.3% of the patients. One patient developed a persistent hemiparesis thought to be related directly to the performance of the arteriogram. On the basis of this review, routine operative arteriography as an adjunct to carotid endarterectomy has been discontinued at out institution. Specific indications for obtaining operative arteriograms are outlined.

Angiography↗
PubMed1984

Intraoperative assessment of carotid endarterectomy by electromagnetic blood flow measurements.

Intraoperative electromagnetic flow meter measurements were made after 143 carotid endarterectomies. Six (4.2 per cent) had low or no internal carotid artery blood flow, and four of these had a clear technical cause. After rearteriotomy, five had restoration of blood flow to the normal range. These data support the hypothesis that there is a small but significant instance of technical causes of immediate carotid endarterectomy failure which may not be detectable by observation and palpation. Postendarterectomy intraoperative internal carotid artery blood flow measurement is an acceptable method of detecting hemodynamically significant technical defects.

Blood Flow Velocity↗
PubMed1978

Prevention of stroke by carotid endarterectomy.

Cerebral stroke can occur in patients having visual symptoms only. Fundoscopy is valuable in identifying those patients with visual symptoms who are likely to have carotid disease; and carotid endarterectomy can prevent a stroke in a significant percentage of patients at risk. Meticulous operative technique is essential. In a series of 187 carotid endarterectomies performed on 154 patients over a 7-year period, the operative mortality rate was zero. Operative morbidity was 1.3% in 139 patients who had no prior permanent neurological deficits, and 13% in 15 patients who had suffered previous strokes. Data compiled on follow-up for an average of 20 months indicated that six patients (4.7%) suffered postoperative strokes, nine patients (7%) experienced persistence of symptoms, and 113 patients (88.3%) remained neurologically well.

Aged↗
PubMed1978

An objective assessment of common femoral endarterectomy and profundaplasty in patients with superficial femoral occlusion.

Common femoral endarterectomy with profundaplasty has become accepted as a useful operation in the treatment of ischemic arterial disease which is the result of superficial femoral occlusion. However, objective assessment of its long-term postoperative hemodynamic effects has not been reported. This study determines the effect of this operation on the resting pressure index, the walking distance on the treadmill, the fall in postexercise ankle pressure, and the recovery time. Measurements were made just before operation and 1 month later in 20 patients with severe claudication and superficial femoral occlusion. Sixteen patients were available for follow-up at 1 year. These patients were matched according to the resting pressure index to another group of 20 patients with superficial femoral occlusion followed up conservatively. The results indicate that common femoral endarterectomy with profundaplasty improves the distal perfusion pressure and, by inference, flow, which provides strong objective confirmation of the clinical impression that this operation is of value and help in determining its place in the management of severe lower limb ischemia.

Aged↗
PubMed1984

[Validation of quantitative and qualitative data of real-time carotid echotomography in comparison with standard Doppler tests, arteriography and anatomopathology. On 59 carotid endarterectomies].

Findings on ultrasound, arteriography and pathology examinations were compared in 49 patients undergoing 59 carotid endarterectomies between December 1981 and April 1983. Carotid artery lesions were investigated routinely by cervical Doppler, high resolution rapid ultrasound and either direct or more usually venous arteriography (with photographic subtractions). Postoperative endarterectomy specimens were examined to determine the exact degree of stenosis, and also qualitatively (gross pathology and histology of ulcerations and thromboses, the biochemical nature of the plaques, etc.). With respect to detection, that is demonstration of the existence or not of an atheromatous lesion, the ultrasonographic findings could always (100% of cases) be correlated with pathology data. Qualitative analysis of atheromatous lesions showed certain to be diagnosed with ease: calcified, fibrous or chondroid and lipidic plaques, while those complicated by hemorrhage, ulceration or mural thrombosis were less constantly diagnosed by ultrasound imaging. Occlusive plaques were easily detected, while recent intraluminal thrombosis was more difficult to diagnose by ultrasound alone. In this case the combined use of Doppler is a valuable aid, and is a routine procedure, in fact, in the department. Results of quantitative analysis showed good correlation between ultrasound and pathology findings in 79.7% of cases (insufficient in 20.3%). However, if ultrasonography is combined with other ultrasound methods of examination (standard Doppler and spectral analysis of Doppler) correlation is of the order of 95%, close to morphological data supplied by arteriography, with in addition a functional and qualitative approach not possible with arteriography alone.

Aged↗
PubMed1984

Moderate hypothermia during carotid endarterectomy.

The present investigation reports 6 cases undergoing carotid endarterectomy, who were operated under moderate hypothermia (28.5-31.5 degrees C) without the use of a shunt; no neurological sequelae were observed post operatively. Moderate hypothermia is recommended as one of the techniques for brain protection in patients undergoing carotid endarterectomy.

Aged↗
PubMed1978

[Ultrasonic endarterectomy].

The authors used a generator of ultrasound oscillations and a special wave conductor in endarterectomy in the clinic and in the experiment. They assess positively the described method of endarterectomy.

Endarterectomy↗
PubMed1984

Carotid endarterectomy without a shunt: the control series.

Nine hundred forty carotid endarterectomies were performed without the use of a temporary indwelling shunt. Six patients (0.6%) died, all from stroke; 17 other patients (1.8%) had another stroke, and 21 patients (2.2%) had temporary neurologic symptoms. Complete x-ray films detailing the opposite internal carotid artery and carotid artery back pressure were available for 783 operations. Correlation of stroke to back pressure, status of the contralateral internal carotid artery, preoperative neurologic deficit, and carotid clamp time was examined. Statistical analysis demonstrated significantly increased neurologic complications only if the systolic carotid back pressure was less than or equal to 50 mm Hg or the contralateral internal carotid artery was occluded. Analysis to determine if these factors were dependently related showed that when both a contralateral carotid occlusion and a carotid back pressure of less than or equal to 50 mm Hg coexisted (82 patients), the rate of permanent deficit was 11.0% compared with 2.8% when either factor was singly present and 0.9% when neither factor was present. No statistical difference exists between the group with only a single factor and those with neither factor. When a temporary shunt is not used during carotid endarterectomy, the risk of neurologic complication is increased if both a contralateral internal carotid artery occlusion and a carotid back pressure of less than or equal to 50 mm Hg coexist. The use of a shunt in this patient population may be beneficial.

Adult↗
PubMed1984

Natural history of carotid artery disease on the side contralateral to endarterectomy.

The natural history of the nonoperated carotid artery opposite an endarterectomy was examined in 134 patients by means of ultrasonic duplex scanning over a period extending to 48 months. None of the nine deaths that occurred during follow-up was stroke related. A total of 22 arteries showed progression of disease over this period. By life-table analysis the mean annual rate of progression for all categories of disease was 12.6% and 7.4% for progression to a diameter reduction greater than 50%. Disease progression was more rapid in patients under 65 years of age. Symptoms occurred in 13 patients for an overall incidence of 10% and a mean annual rate estimated at 5%. All symptoms indicated transient ischemic attacks; there were no strokes. There was a strong relationship between the development of symptoms and stenoses greater than 80% either at the initial examination or secondary to progression. No correlation was found between the presence of bruits or their change over time and the progression or appearance of symptoms. Conservative management of nonoperated vessels opposite an endarterectomy appears appropriate until symptoms develop or a lesion greater than 80% is detected.

Adult↗
PubMed1984

Does contralateral carotid occlusion influence neurologic fate of carotid endarterectomy?

Divergent opinions regarding operative risks and late prognosis of patients undergoing endarterectomy for carotid stenosis with contralateral carotid occlusion have prompted a review of the experience at Emory University Hospital from Jan. 1, 1978, through Dec. 31, 1982. Fifty-four patients (37 men, 17 women; mean age 63 years) who underwent carotid endarterectomy (CEA) with contralateral carotid occlusion (group I) were compared with 410 demographically similar patients without contralateral carotid occlusion (group II) who underwent 503 CEAs during the same interval. CEA indications in group I were the following and were proportionately similar to those of group II: hemispheric transient ischemic attacks, 22 patients; asymptomatic stenosis, 12 patients; nonhemispheric symptoms, 11 patients; previous cerebral infarction, eight patients; and vascular tinnitus, one patient. General anesthesia, routine intraluminal shunting, systemic heparinization, and arteriotomy closure without patch were routinely employed in both groups. Three patients in group I suffered permanent neurologic deficits after operation (5.6%) and two had transient postoperative deficits with complete recovery. Ten patients (2.0%) in group II suffered permanent neurologic deficits and 10 patients experienced transient neurologic events after operation. Neither the transient nor the permanent neurologic deficit rates were statistically different (p greater than 0.05; Fisher exact test) in the two groups. Operative mortality rates for group I and group II were 0% and 0.8%, respectively, and were not significantly different (p greater than 0.10; Fisher exact test). Late postoperative ischemic brain infarctions occurred in two patients in group I (3.8%) and in 13 patients (3.6%) in group II (p greater than 0.10; Fisher exact test). Kaplan-Meier survival analyses were virtually identical in both groups, with the majority of deaths caused by cardiac occlusion may undergo CEA with morbidity and mortality rates similar to those without contralateral occlusions. Contralateral carotid occlusion does not necessarily portend an unfavorable early or late prognosis after CEA.

Adult↗
PubMed1984

[Extensive endarterectomy of the left anterior descending artery].

Diffuse obstructive disease of the left anterior descending coronary artery presents a new challenge to the surgeon especially if the heart and septal muscle supplied by this vessel is ischaemic but viable. Venous skips were utilized in the past to overcome this problem, but recently extensive endarterectomy of this system has been advocated. The case studies of 5 patients are presented who have undergone extensive endarterectomy of the left anterior descending artery and coronary bypass grafting.

Arterial Occlusive Diseases↗
PubMed1983

Neurologic deficit after carotid endarterectomy: pathogenesis and management.

During a 7-year period, 818 patients underwent carotid endarterectomy (CE) and were evaluated for postoperative neurologic deficits. Three hundred and eighteen had CE performed with a shunt; transient deficits occurred in 2.9% (nine patients) and permanent deficits occurred in 1.6% (five patients). CE was performed without a shunt in 274 patients; transient deficits occurred in 2.9% (eight patients), while permanent deficits occurred in 2.2% (six patients). CE was monitored by surveillance in 226 patients; transient deficits were found in 2.2% (five patients), while permanent deficits occurred in 1.6% (four patients). There was no significant difference in the incidence of postoperative neurologic deficits between the groups (P greater than 0.25). The concept of inadequate collateral cerebral flow during endarterectomy could not, therefore, be indicted as the cause of the postoperative neurologic complications. Technical errors that caused carotid thrombosis or cerebral emboli, and not inadequate collateral cerebral flow, accounted for most of the neurologic deficits after CE. Deficits occurred most frequently in neurologically unstable patients, those who were first seen with stroke in evolution or with postreversible ischemic neurologic deficit and poststroke symptoms. Twenty-two patients awoke from CE with minor transient deficits, and neurologic function rapidly returned. Fifteen patients with profound postoperative deficits had reoperations immediately; intracranial emboli were identified in three patients, while a thrombosed CE site was demonstrated in seven. Three late (greater than 6 hours) postoperative deficits were due to thrombosis of the CE site. Patients with minimal postoperative deficits will improve without intervention, but reoperation is mandatory if a major deficit occurs in the immediate postoperative period. A protocol for the management of the post-CE neurologic deficit is presented.

Adult↗
PubMed1983

Carotid endarterectomy.

Carotid endarterectomy should be limited to selected patients who are good risks with definitive diagnostic criteria. The author discusses indications for carotid endarterectomy, postoperative management and timing, and operative technique.

Carotid Artery Diseases↗