Document Detail


The influence of routine completion arteriography on outcome following carotid endarterectomy.
MedLine Citation:
PMID:  9061134     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The necessity for routine completion arteriography (RCA) following carotid endarterectomy (CEA) is controversial, with the reported yield of clinically significant findings varying from 3% to 16%. In order to determine the utility of RCA, we reviewed completion studies in 154 consecutive CEAs, defined the frequency and characteristics of arteriographic defects, and correlated RCA defects with early outcome (internal carotid artery [ICA] occlusion, stroke) and late restenosis. All intraoperative RCAs were reviewed by two blinded observers and categorized into three subsets: Group A (n = 69) normal; Group B (n = 29), abnormal, severe defects; Group C (n = 56), abnormal, mild-moderate defect. RCA detected 32 defects in Group B: 10 internal carotid (ICA), seven endpoint flaps, two kinks, one dissection; 16 external carotid (ECA), 10 severe endpoint defects and six total occlusion; six common carotid (CCA), five irregular proximal shelfs, one web. Thirty of 32 defects were successfully repaired as confirmed by normal repeat RCA studies; one ECA defect was not repaired and the ICA dissection was irreparable. In Group C, 67 mild-moderate defects were identified, but not corrected. These included < 30% stenosis in the ICA (12), ECA (18), CCA (24), and vein patch corrugation or irregularity (13). For the entire series the postoperative ICA occlusion rate was 2% (3/154), stroke rate 2.6% (4/154), and a subsequent > 50% restenosis rate of 7% (11/154). The yield from routine carotid completion arteriograms was significant, with 19% of studies identifying a severe defect that required repair. Although the difference in stroke rates and restenosis between the different groups did not reach statistical significance, patients with normal intraoperative arteriograms initially or after correction of a significant RCA defect had no early carotid occlusion (p = 0.05, Fisher's exact test) compared to patients with residual RCA defects. All early carotid occlusions occurred in patients with unrepaired defects. We conclude that RCA is an important method of quality control after CEA and exerts a subtle, but real, reduction in postoperative complications.
Authors:
A Westerband; J L Mills; S S Berman; G C Hunter
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  11     ISSN:  0890-5096     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-05-22     Completed Date:  1997-05-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  14-9     Citation Subset:  IM    
Affiliation:
Section of Vascular Surgery, University of Arizona Health Sciences Center, Tucson 85724, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Carotid Stenosis / epidemiology,  radiography*,  surgery*
Cerebral Angiography / utilization*
Cerebrovascular Disorders / epidemiology,  prevention & control
Diagnostic Tests, Routine / utilization
Endarterectomy, Carotid*
Female
Humans
Intraoperative Care / methods
Male
Postoperative Complications / epidemiology,  prevention & control
Recurrence
Retrospective Studies
Risk Factors
Treatment Outcome

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


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