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Value of intraoperative duplex imaging during supervised carotid endarterectomy
T S Padayachee1, C L McGuinness, K B Modaresi
1Ultrasonic Angiology Laboratory, King's College London and Department of Surgery, Guy's and St Thomas's Hospital Trust, London, UK. soundrie.padayachee@kcl.ac.uk
Background:
For overall benefit, carotid endarterectomy requires low perioperative morbidity and mortality rates. Carotid thrombosis is usually secondary to technical error, which may be related to the experience of the operator. In this retrospective study the clinical and technical outcome of carotid endarterectomies performed by one consultant and five trainees were compared.
Methods:
Some 149 patients underwent carotid endarterectomy; 89 were operated on by the consultant and 60 by trainees. Intraoperative duplex imaging of the carotid repair was performed before wound closure, and re-exploration was carried out when there was a residual severe stenosis associated with an intimal flap.
Results:
There was no significant difference in clinical outcome between operations done by consultant or trainees. There was a significant increase in the number of stenoses, kinks and flaps in carotid endarterectomies performed by trainees compared with those of the consultant both before (chi2 = 12.0, 1 d.f., P < 0.001) and after (chi2 = 10.1, 1 d.f., P < 0.001) correction.
Conclusion:
Intraoperative duplex imaging may facilitate training by providing an objective assessment of the quality of the operation.