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Carotid endarterectomy prior to major abdominal aortic surgery
J F Bechtel1, C Bartels, S Hopstein
1Department of Vascular Surgery, Krankenhaus Porz am Rhein, Teaching Hospital, University of Cologne, Germany. bechtel@medinf.mu-luebeck.de
Insights
Carotid endarterectomy (CEA) before major aortic surgery is safe for patients with high-grade carotid artery occlusive disease (CAOD). This approach leads to excellent neurologic outcomes, reducing stroke risk during these high-risk procedures.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Major aortic surgery presents a significant stroke risk.
- Carotid artery occlusive disease (CAOD) is a known risk factor for stroke in these patients.
- Carotid endarterectomy (CEA) is effective for long-term stroke prevention in high-grade CAOD, but its role before aortic surgery was unstudied.
Purpose of the Study:
- To evaluate the safety and efficacy of performing CEA prior to major aortic surgery.
- To assess the impact of CEA on perioperative stroke risk in patients undergoing major aortic procedures.
Main Methods:
- Prospective observational study of 201 patients undergoing major aortic surgery.
- Non-invasive screening for CAOD using Doppler ultrasonography.
- 41 patients with confirmed high-grade CAOD underwent CEA before aortic surgery.
Main Results:
- No mortality or morbidity associated with CEA.
- Perioperative mortality for major aortic reconstruction was 3.5%.
- No new focal neurologic deficits occurred post-CEA, except one fatal stroke in a patient not indicated for CEA.
Conclusions:
- CEA can be safely performed before major aortic surgery.
- This strategy yields excellent neurologic outcomes for patients with high-grade CAOD.
- Recommend screening for high-grade CAOD before aortic surgery, with CEA performed first if indicated.
Background:
Major aortic surgery carries a high risk of stroke. Carotid artery occlusive disease (CAOD) has been identified as one of the contributing risk factors. Regarding the long-term prevention of stroke, carotid endartectomy (CEA) seems to be superior to the best medical treatment in patients with high-grade CAOD. However, the role of CEA prior to major aortic surgery has not been studied.
Design:
Prospective study, observational design.
Subjects And Setting:
201 patients referred to a community hospital for major aortic surgery.
Intervention:
The patients were non-invasively screened by continuous-wave and duplex Doppler ultrasonography for the presence of CAOD. In 41 patients with angiographically confirmed high-grade CAOD, CEA was performed prior to major aortic surgery.
Main Outcome Measure:
Combined mortality and major morbidity from CEA and abdominal aortic surgery.
Results:
There was no mortality or morbidity related to CEA. Total perioperative mortality related to major aortic reconstruction was 3.5%. No new perioperative focal neurologic deficits occurred except for one fatal stroke in a patient in whom CEA had been judged not to be indicated.
Conclusions:
CEA can be performed safely prior to major aortic surgery resulting in excellent overall neurologic outcome in patients with high-grade CAOD. We propose that patients scheduled for major aortic surgery be screened for the presence of high-grade CAOD and that CEA be performed first, if indicated according to published guidelines.