Document Detail

Prevalence of asymptomatic carotid stenosis in patients undergoing infrainguinal bypass surgery.
MedLine Citation:
PMID:  7632153     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The prevalence of asymptomatic carotid stenosis in patients with lower-extremity ischemia is unknown. This report represents the largest carotid screening program to date of patients undergoing leg bypass. DESIGN: Patients undergoing infrainguinal bypass from 1987 through 1993 on the vascular surgery service at Oregon Health Sciences University, Portland, underwent routine carotid duplex examinations to detect the presence of asymptomatic carotid stenosis. PATIENTS: During the study period, 352 patients underwent infrainguinal revascularization for ischemia, of whom 225 (64%) had no prior carotid surgery, carotid arteriography, or cerebrovascular symptoms. There were 117 men and 108 women, with a mean age of 67 years. The indication for surgery was limb salvage in 67% and claudication in 33% of patients. RESULTS: Sixty-four patients (28.4%) who required lower-extremity revascularization had hemodynamically significant asymptomatic carotid artery stenosis or occlusion; 12.4% had stenosis of 60% or greater, the qualifying level for randomization in the Asymptomatic Carotid Atherosclerosis Study. Based on these findings, eight patients with carotid stenosis of 80% or greater underwent elective carotid endarterectomy. There were no postoperative neurologic events in the 225 leg bypass patients. By multivariate logistic regression analysis, the presence of carotid bruit (P < .001) and the presence of rest pain (P = .006) were associated with carotid stenosis of 50% or greater. Limiting screening to patients with carotid bruit, limb salvage indications for surgery, and/or advanced age excluded significant numbers of patients with stenosis; thus, these were not effective screening strategies. CONCLUSION: Screening carotid duplex scanning is indicated in patients who require lower-extremity revascularization.
A T Gentile; L M Taylor; G L Moneta; J M Porter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  130     ISSN:  0004-0010     ISO Abbreviation:  Arch Surg     Publication Date:  1995 Aug 
Date Detail:
Created Date:  1995-09-07     Completed Date:  1995-09-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  900-4     Citation Subset:  AIM; IM    
Department of Surgery, Oregon Health Sciences University, Portland, USA.
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MeSH Terms
Arterial Occlusive Diseases / complications*,  surgery
Carotid Stenosis / complications*,  ultrasonography
Cross-Sectional Studies
Logistic Models
Mass Screening
Middle Aged
Patient Selection
Popliteal Artery* / surgery
Preoperative Care
Prospective Studies
Ultrasonography, Doppler, Duplex

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

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