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[Assessment of intraoperative duplex sonography during carotid endarterectomy]
P U Reber1, N Ghisletta, H Hakki
1Abteilung für Gefässchirurgie, Klinik für Herz- und Gefässchirurgie, Inselspital, Universität Bern, Germany. Peter.Reber@neuehorizonte.ch
Insights
Intraoperative duplex sonography during carotid endarterectomy (CEA) effectively identifies technical issues. This diagnostic tool helps prevent serious complications like stroke and restenosis, improving patient outcomes.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Neurology
Background:
- Carotid endarterectomy (CEA) is crucial for stroke prevention but demands high surgical skill.
- Intraoperative monitoring of endarterectomized arteries is infrequently performed.
- Potential intraoperative technical problems can lead to severe cerebral damage.
Purpose of the Study:
- To evaluate the utility of intraoperative color-coded duplex sonography.
- To determine its effectiveness in identifying technical issues during CEA.
- To assess its role in preventing neurological deficits.
Main Methods:
- Prospective analysis of patients undergoing CEA for high-grade carotid stenosis (1996-1999).
- Intraoperative duplex sonography used to assess the adequacy of the repair.
- Data collected on patient demographics, procedural outcomes, and complications.
Main Results:
- Duplex sonography revealed abnormalities in 7% of 151 CEAs, with 3% requiring immediate revision.
- Low rates of temporary neurologic deficit (0.7%) and fatal intracerebral hemorrhage (1.3%) were observed.
- Postoperative complications included wound hematoma and cranial nerve palsy; no late neurologic events occurred.
Conclusions:
- Routine intraoperative duplex sonography is a reliable tool for detecting correctable technical problems during CEA.
- This monitoring can prevent neurological deficits, fatal strokes, and high restenosis rates.
- The technique enhances surgical safety and improves long-term patient outcomes.
Introduction:
Carotid endarterectomy (CEA) for prevention of strokes mandates a high amount of experience and a meticulous surgical technique. Intraoperative morphologic as well as hemodynamic monitoring of the endarterectomized arteries is rarely performed. The purpose of this study was to determine the value of intraoperative colour-coded-duplex-sonography to recognize eventual intraoperative technical problems that might result in serious cerebral damage.
Methods:
Prospective analysis of the medical data of all patients who underwent CEA for treatment of high-grade carotid stenosis between 1996 and 1999. Adequacy of the repair was assessed intraoperatively by duplexsonography.
Results:
Of 142 consecutive patients with a median age of 68 (43-84) years, 104 (73 %) were men and 38 (27 %) were women. 9 patients (6 %) had bilateral CEAs. Intraoperative duplexsonography revealed abnormalities during 11 (7 %) of 151 CEAs. 4 (3 %) were considered major and underwent immediate revision. There was one (0.7 %) temporary neurologic deficit (hyperperfusion syndrome) and 2 (1.3 %) cases of fatal intracerebral hemorrhage. 6 (4 %) postoperative surgical complications occurred, i. e. 3 cases of major wound hematoma (with revision) and 3 cases of temporary cranial nerve palsy. Median length of follow-up was 11 (3-35) months. No late neurologic event occurred during follow-up. 5 (3 %) patients developed asymptomatic restenosis.
Discussion:
Routine intraoperative duplexsonography is a valuable and reliable diagnostic tool to detect correctable technical problems during CEA that subsequently may lead to neurological deficits, fatal stroke or a high incidence of restenosis.