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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.
Insights
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.
Purpose:
We analyzed operations performed at our institution retrospectively for recurrent carotid artery stenosis to assess the indication for surgery. We also assessed the techniques used for these operations.
Patients And Methods:
From January 1992 to December 1998 1210 carotid endarterectomies were performed. Forty two (3.4%) of these were for recurrent stenosis. A new vein patch was implanted in 27 cases, PTFE patches were used in nine cases. In six cases an interposition with the great saphenous vein was performed.
Results:
The mean interval between primary and secondary procedure was 60. 2months (3months to 23yr). Twenty five of our 41 patients had had ipsilateral neurologic symptoms before redo surgery, the remainder were free of symptoms. The grade of stenosis was over 90% in 22 cases, between 75 and 90% in 11 cases and below 75% in nine cases, two cases had aneurysmatic lesions. None of the patients died in the 30day observation period. One patient had a stroke with a permanent neurological deficit. In two cases postoperative bleeding occurred requiring reexploration. Two patients developed hypoglossal neurapraxia and in four patients the recurrent laryngeal nerve was injured. One patient had an apneic episode in the recovery room.
Conclusion:
The reported incidence of recurrent carotid artery stenosis surgery ranges from 3 to 36% and our incidence is at the lower end of this range. The surgical results of reoperating are acceptable with a low incidence of complications.
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