Document Detail


Is routine duplex examination after carotid endarterectomy justified?
MedLine Citation:
PMID:  2204737     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Routine follow-up of patients after carotid endarterectomy with duplex scanning is commonly practiced, yet the clinical significance of identifying those with asymptomatic restenosis is unclear. To address this issue we reviewed 120 consecutive patients who underwent 143 carotid endarterectomies from August 1983 to December 1988. One hundred one patients (118 operations) were available for clinical follow-up, and the overall incidence of recurrent symptoms was 6% (6/101). Sixty-three of these patients (78 carotid endarterectomies) had postoperative duplex examination. Two had evidence of residual disease from the time of surgery and were not included in further analysis. Significant recurrent stenosis (greater than 50% diameter reduction) developed in 14 of the remaining 76 arteries (18.2%). Twelve of 14 stenoses remained asymptomatic during follow-up from 18 to 72 months (mean 47.0 months) and did not undergo reoperation. Recurrent ipsilateral hemispheric symptoms developed in two patients with restenosis (14.3%). Four of the 62 arteries without significant recurrent stenosis developed ipsilateral symptoms (6.5%), but none required reoperation during follow-up from 1 to 71 months (mean 31.6 months). Life-table analysis showed no increased risk of transient ischemic attack, stroke, or death in patients with restenosis. This study supports regular clinical follow-up after carotid endarterectomy with emphasis on patient education in the recognition of symptoms. Although duplex scanning may be useful to follow known contralateral asymptomatic disease or evaluate those with recurrent symptoms, its routine use to identify patients with asymptomatic restenosis after carotid endarterectomy may be unnecessary.
Authors:
J M Cook; B W Thompson; R W Barnes
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  12     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1990 Sep 
Date Detail:
Created Date:  1990-10-16     Completed Date:  1990-10-16     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:  334-40     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Arkansas for Medical Sciences, John L. McClellan Memorial Veterans Administration Hospital, Little Rock 72205.
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MeSH Terms
Descriptor/Qualifier:
Aged
Carotid Artery Diseases / diagnosis,  epidemiology,  surgery*
Case-Control Studies
Constriction, Pathologic / diagnosis,  epidemiology,  surgery
Endarterectomy*
Female
Humans
Life Tables
Male
Postoperative Care
Recurrence
Reoperation
Ultrasonics
Ultrasonography*

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


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