Document Detail

Carotid endarterectomy: technical practices of surgeons participating in the GALA trial.
MedLine Citation:
PMID:  18639475     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Recent meta-analyses confirm an advantage to patch angioplasty during carotid endarterectomy (CEA) and suggest a benefit from routine shunting. GALA Trial (RCT: general [GA] versus local [LA] anaesthesia for CEA) collaborators (non-UK [European] and UK) were surveyed to assess current practice techniques. MATERIALS AND METHODS: Postal questionnaires determined: shunt usage, monitoring techniques dictating shunt deployment, criteria for patching and the influence of anaesthetic technique upon these decisions. RESULTS: 157/216 surgeons (73%) replied. For UK surgeons (n=76) performing GA CEA a shunt was always, never, or selectively used by 73.6%, 4.2% and 22.2% respectively. Figures for non-UK surgeons (n=77) were 20.8% (p<0.0001), 26% (p<0.0002) and 53.2% (p<0.0001). When shunting selectively, fewer UK surgeons relied on stump pressure (26.4% v 48.1%; p<0.0064) with TCD more widely used (38.9% v 11.7%; p<0.0001). Shunting criteria during LA CEA were the same for both groups (impaired awake-testing). Routine patching was commoner amongst UK surgeons (GA: 76.4% v 34.2%, p<0.0001; LA: 70.1% v 31.9%, p<0.0001). CONCLUSIONS: These results indicate that more UK surgeons have adopted current suggestions for improving CEA outcomes. Future analysis of unblinded GALA Trial data may provide further information about the impact of different policies for shunting and patching.
H R S Girn; D Dellagrammaticas; K Laughlan; M J Gough;
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Publication Detail:
Type:  Journal Article     Date:  2008-07-17
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  36     ISSN:  1532-2165     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-15     Completed Date:  2008-10-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  385-9     Citation Subset:  IM    
Leeds Vascular Institute, Leeds General Infirmary, Great George Street, Leeds, UK.
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MeSH Terms
Anesthesia, General
Anesthesia, Local
Angioplasty / methods
Carotid Artery Diseases / surgery
Carotid Artery, Internal / surgery
Data Collection
Endarterectomy, Carotid / methods*
Great Britain
Monitoring, Intraoperative

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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