Document Detail


Mini skin incision for carotid endarterectomy (CEA): a new and safe alternative to the standard approach.
MedLine Citation:
PMID:  16376196     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Patients requiring surgery are naturally attracted to shorter incisions because they tend to cause less pain and are esthetically more appeasing. To substantially shorten the length of standard skin incisions (4 to 7 inches) for carotid endarterectomy (CEA), we used preoperative duplex scanning to outline the carotid bifurcation as well as to determine the extent of disease in both the internal and common carotid arteries.
METHODS: During the last 21 months, 265 consecutive primary CEAs were performed in 253 patients (mean age 72 +/- 10 years) at a single institution. Of these, 142 were men (56%). Hypertension, coronary artery disease, diabetes mellitus, smoking, and chronic renal failure were present in 81%, 44%, 43%, 28%, and 19% of the patients, respectively. Neurologically asymptomatic patients accounted for 71% of the cases. All patients received general anesthesia. Duplex-assisted skin markings of the diseased carotid artery were performed after proper patient positioning on the operating table. Synthetic patches were routinely used, and intraluminal shunts were deemed necessary by low stump pressures in 64 cases (24%). Completion duplex scanning was performed in all cases.
RESULTS: The length of the longitudinal skin incision varied from 0.8 to 3.5 inches (average 1.4 +/- 0.5 inches). It was < or = 1 inch in 56 cases (21%), 1.1 to 1.5 inches in 110 (42%), 1.6 to 2 inches in 85 (32%), and 2.1 to 3.5 inches in the remaining 14 cases (5%). Intraluminal shunts were required in 9 (16%), 18 (16%), 29 (34%), and 8 (57%) of the cases, respectively. Incisions were longer in cases requiring an indwelling shunt (1.6 +/- 0.6 inches vs 1.4 +/- 0.4 inches) (P < .0001). The average patch length was 1.3 +/- 0.3 inches (range, 0.7 to 2.6 inches). The skin incision averaged 1.54 +/- 0.45 inches for the first 133 cases and 1.35 +/- 0.45 inches for the remaining 132 cases (P < .0001). Technical defects occurred in 10 cases (3.8%). The overall incidence of ipsilateral stroke and death was 1.9% and 0%. There were no technical defects or strokes in patients with the shortest incisions (< or = 1 inch). Overall, there were three transitory peripheral nerve injuries (1.1%). A comparative analysis with 265 consecutive CEAs performed immediately before this series without duplex-assisted skin markings revealed no significant differences in age (71 +/- 11 years), incidence of neurologically symptomatic patients (26%), sex (60% men), shunt use (24%), and major technical defects (3%). Also, postoperative transitory peripheral nerve injury (0.8%), stroke (0%), and death (0%) were not significantly different from the duplex-assisted group. It is of interest to note that none of the former cases was performed with a skin incision < or = 2 inches.
CONCLUSION: Most CEAs (95%) can safely be performed with < or = 2-inch skin incisions. Pre-CEA duplex-assisted skin marking is a novel approach that confirms the side of the operation, localizes the disease, and minimizes the magnitude of the operation via shorter, more esthetically pleasing incisions.
Authors:
Enrico Ascher; Anil Hingorani; Natalie Marks; Richard W Schutzer; Manikyam Mutyala; Suresh Nahata; William Yorkovich; Theresa Jacob
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  42     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-26     Completed Date:  2006-01-12     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1089-93     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY, USA. eascher@maimonidesmed.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Carotid Artery, Common*
Carotid Artery, Internal*
Carotid Stenosis / surgery*,  ultrasonography
Endarterectomy, Carotid / methods*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Preoperative Care / methods*
Skin / surgery*
Treatment Outcome
Ultrasonography, Doppler, Duplex

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


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