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Redo surgery for carotid artery stenosis: when and how?
M Gorlitzer1, B Heine, H Mendel
1Department of Cardiovascular Surgery, Hospital Lainz, Wolkersbergenstrasse 1, A-1130, Vienna, Austria.
Cardiovascular Surgery (London, England)
|August 26, 2000
Summary
Surgery for recurrent carotid artery stenosis is acceptable with a low complication rate. This retrospective analysis assessed surgical indications and techniques for these procedures.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Surgical Outcomes
Background:
- Recurrent carotid artery stenosis (RCAS) is a potential complication after carotid endarterectomy.
- The incidence of RCAS requiring reoperation varies significantly in the literature.
Purpose of the Study:
- To retrospectively analyze surgical operations for recurrent carotid artery stenosis.
- To assess the indications for reoperation and the surgical techniques employed.
Main Methods:
- A retrospective review of 1210 carotid endarterectomies performed between January 1992 and December 1998.
- Analysis of 42 cases (3.4%) performed for recurrent stenosis.
- Evaluation of different patch materials (vein, PTFE) and interposition grafts used.
Main Results:
- The mean interval between primary and secondary surgery was 60.2 months.
- Twenty-five patients (60%) had pre-operative neurological symptoms.
- High-grade stenosis (>75%) was present in 33 cases; two had aneurysms.
- No 30-day mortality; one stroke, two re-explorations for bleeding, two hypoglossal neurapraxias, four recurrent laryngeal nerve injuries, one apneic episode.
Conclusions:
- The incidence of recurrent carotid artery stenosis surgery at this institution (3.4%) is at the lower end of the reported range (3-36%).
- Surgical reoperation for recurrent carotid artery stenosis yields acceptable results with a low incidence of complications.