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Carotid endarterectomy in patients with significant renal dysfunction
W C Sternbergh1, C L Garrard, M D Gonze
1Ochsner Clinic and Foundation, New Orleans, LA 70121, USA.
Journal of Vascular Surgery
|April 9, 1999
Summary
Carotid endarterectomy (CEA) is safe for patients with end-stage renal disease (ESRD) or chronic renal insufficiency (CRI), showing similar perioperative risks to other patients. However, long-term benefits for asymptomatic ESRD patients are questionable due to high mortality rates.
Area of Science:
- Vascular Surgery
- Nephrology
- Cardiovascular Medicine
Background:
- Recent reports questioned the safety of carotid endarterectomy (CEA) in patients with end-stage renal disease (ESRD) due to high perioperative risks.
- Previous studies were based on limited patient numbers, necessitating further investigation into CEA outcomes for renal insufficiency patients.
Purpose of the Study:
- To evaluate the perioperative and long-term outcomes of CEA in patients with chronic renal insufficiency (CRI) and ESRD.
- To compare the safety and efficacy of CEA in patients with varying degrees of renal dysfunction.
Main Methods:
- A retrospective review of 1081 CEA patients between 1990 and 1997.
- Cross-referencing CEA patients with diagnosed renal insufficiency (CRI and ESRD).
- Comparison with a control group of patients undergoing CEA during 1993.
Main Results:
- Fifty-one CEAs were performed in 44 patients with CRI and ESRD.
- The CRI+ESRD group had no perioperative strokes, with a combined stroke-mortality rate of 2.0%, comparable to the control group's 2.6%.
- Long-term survival rates at 4 years were 12% for ESRD, 54% for CRI, and 72% for controls (P <.05).
Conclusions:
- CEA can be performed safely in patients with ESRD or CRI, with perioperative outcomes similar to those without renal dysfunction.
- The long-term benefit of CEA for stroke prevention in asymptomatic ESRD patients is uncertain due to their high mortality rate.