[Evolution and change of strategy in carotid artery surgery in Debrecen]

In the 1st Department of Surgery, in Debrecen, operations on supraaortic arteries are done, since 1985. In the first five years, sporadically, only 2-3 carotid reconstruction have been done. Between 1990-1996 the number of these operations were about 20 per year, although the number of postoperative complications were around 1%. The number of operative interventions on the carotid region were doubled in 1997 and from 1999 were four times more. The authors analysed the data of the patients, accumulated in the last 6 years. In this period 258 operations were done. Unilateral significant stenosis found in 159 (61%) patients and bilateral serious stenosis or unilateral occlusion in 99 (38.6%) patients. 22.4% of the patients who were operated in our department, were waiting for coronary revascularisational operation because of angina pectoris. 5.4% suffered from vitium and were later undergone cardiac valve operation. By 24% of the patients later, electively we performed reconstructional vascular operation on the lower limbs. The base of preoperative examinations was cerebrovascular circulational insufficiency by almost half of the patients (46.1%). Beside anaesthesiological basic examinations, detailed diagnostics (exercised EKG, TTE, coronariography, Holter monitor) were done. In the overwhelming majority of the operations we used the eversion technique. The surgical interventions were performed in every case using non-invasive haemodynamical monitor (transoesophageal doppler ODM-II). Our results meet the requirement of the national and international standouts. These results prove, that with the help of comprehensive pre-operational examinations and preparation, intraoperative monitor and having up-to-date, precise operational technique, the international standards can be sustained even treating patients with such a high risk.