Document Detail

Aortic arch angiography prior to carotid endarterectomy. Is its continued use justified?
MedLine Citation:
PMID:  9236704     Owner:  NLM     Status:  MEDLINE    
Patients with significant stenosis at the carotid bifurcation are traditionally subjected to four vessel aortic arch angiography prior to consideration for carotid endarterectomy. The advent of the non-invasive vascular laboratory has necessitated a reappraisal of this approach. AIMS: 1. Determine the yield from aortic arch angiography and its influence on surgical management. 2. Evaluate the accuracy of clinical examination and the non-invasive vascular laboratory in the detection of aortic arch branch lesions. METHODS: One hundred and twenty-nine consecutive patients undergoing evaluation for carotid endarterectomy were prospectively enrolled into the study. The protocol entailed: 1. Clinical recording of upper limb pulses, blood pressure and supraclavicular bruits. 2. Duplex scan examination to evaluate proximal inflow into the carotid arteries. 3. Four vessel aortic arch angiography to detect aortic branch lesions. Data from the non-invasive tests were compared to angiography. Patients with aortic arch branch lesions were further evaluated to determine the proportion requiring additional surgery. RESULTS: Nineteen patients had angiographic evidence of aortic branch disease (14.7%); six involved the common carotid artery, three the innominate artery and 10 the subclavian artery. All of these lesions were detected by the combination of unequal blood pressure, pulse deficit, bruit or duplex scan. Seven patients underwent additional surgery (5.4%) which included carotid-subclavian bypass (five), aortoinnominate bypass (one) and innominate endarterectomy (one). CONCLUSION: In patients with significant stenosis at the carotid bifurcation undergoing evaluation for carotid endarterectomy, aortic arch angiography is unnecessary except in a small percentage of patients with abnormal clinical and non-invasive findings.
A M Kadwa; J V Robbs; A T Abdool-Carrim
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  13     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-08-21     Completed Date:  1997-08-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  527-30     Citation Subset:  IM    
Metropolitan Vascular Service, University of Natal, Durban, South Africa.
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MeSH Terms
Aorta, Thoracic / radiography*
Aortic Diseases / complications,  radiography*,  surgery
Aortography / standards*
Carotid Stenosis / complications,  radiography*,  surgery
Endarterectomy, Carotid*
Middle Aged
Patient Selection
Preoperative Care*
Prospective Studies
Reproducibility of Results
Ultrasonography, Doppler, Duplex / standards

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