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The safety of carotid endarterectomy in patients with preoperative renal dysfunction

Todd Reil1, Shant Shekherdimian, Pamela Golchet

  • 1Division of Vascular Surgery, Gonda (Goldschmied) Vascular Center, UCLA Center for Health Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA 90095-6904, USA.

Annals of Vascular Surgery
|April 25, 2002
PubMed

Insights

Carotid endarterectomy (CEA) is safe for patients with renal dysfunction, contrary to prior data. Careful cardiac monitoring is essential due to a higher risk of myocardial infarction in this group.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Cardiology

Background:

  • Published data indicate high perioperative stroke and death rates for carotid endarterectomy (CEA) in patients with renal dysfunction.
  • This study challenges existing literature by examining CEA safety in patients with impaired kidney function.

Purpose of the Study:

  • To test the hypothesis that carotid endarterectomy (CEA) is a safe procedure for patients with renal insufficiency.
  • To compare outcomes and risk factors in patients undergoing CEA based on preoperative creatinine levels.

Main Methods:

  • Retrospective review of 398 carotid endarterectomy (CEA) procedures performed by a single surgeon between 1988 and 1998.
  • Patients were stratified by preoperative creatinine levels (normal: Cr ≤ 1.5; abnormal: Cr > 1.5).
  • Analysis included patient demographics, perioperative adverse events, and procedural details.

Main Results:

  • Carotid endarterectomy (CEA) was found to be safe in patients with renal dysfunction, with no increased perioperative stroke or death rates.
  • Patients with renal insufficiency undergoing CEA showed no significant increase in stroke or mortality.
  • An increased rate of myocardial infarction was observed, necessitating preoperative cardiac evaluation and monitoring.

Conclusions:

  • Carotid endarterectomy (CEA) can be performed safely in patients with renal dysfunction.
  • Renal insufficiency does not preclude safe CEA, but requires heightened cardiac vigilance.
  • Close cardiac monitoring and preoperative evaluation are crucial for patients with renal insufficiency undergoing CEA.

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