Document Detail


The evolving surgical management of recurrent carotid stenosis.
MedLine Citation:
PMID:  1522637     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The traditional approach to recurrent carotid stenosis has been repeat endarterectomy or patch angioplasty. Concern with the durability of repeat carotid endarterectomy has resulted in our use of carotid resection with autogenous graft interposition. This study was designed to determine the outcome and efficacy of carotid resection compared with repeat carotid endarterectomy in the management of recurrent carotid stenosis. From 1974 to 1991, 162 operations (repeat carotid endarterectomy 105, carotid resection 57) were performed for recurrent carotid stenosis. Indication for operation was hemispheric symptoms in 63% of patients, nonlateralizing symptoms in 25%, asymptomatic stenosis in 7%, and previous stroke in 5%. Ninety-one percent of patients had stenosis greater than 90% on arteriography. The perioperative stroke rate for carotid resection was 3.5%, with a subsequent rate of 0.0064 strokes per year. For repeat carotid endarterectomy, the perioperative stroke rate was 1.9% with a subsequent rate of 0.011 strokes per year. Graft patency after carotid resection was 93% (mean follow-up, 35 months). Four patients treated with carotid resection had graft thrombosis, and two of the four remained asymptomatic. After repeat carotid endarterectomy, one patient had carotid thrombosis, and recurrent stenosis greater than 50% developed in 23 patients (mean follow-up, 64 months). Twenty patients treated with repeat carotid endarterectomy underwent an additional operation for further symptomatic recurrent carotid stenosis. We conclude carotid resection is a safe and effective alternative to repeat carotid endarterectomy for patients undergoing operation for recurrent carotid stenosis.
Authors:
G S Treiman; J M Jenkins; W H Edwards; W Barlow; W H Edwards; R S Martin; J L Mulherin
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  16     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1992 Sep 
Date Detail:
Created Date:  1992-10-15     Completed Date:  1992-10-15     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:  354-62; discussion 362-3     Citation Subset:  IM    
Affiliation:
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Vessel Prosthesis*
Carotid Arteries / surgery*
Carotid Stenosis / epidemiology,  surgery*
Cerebrovascular Disorders / epidemiology
Endarterectomy, Carotid*
Female
Humans
Incidence
Life Tables
Male
Postoperative Complications / epidemiology
Recurrence
Reoperation
Saphenous Vein / transplantation

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


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