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Preoperative duplex on admission prevents unnecessary carotid surgery
1Nuffield Department of Surgery, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
Insights
Preoperative duplex ultrasound on admission for carotid endarterectomy surgery helps avoid unnecessary procedures. This diagnostic tool identified occlusions in 5% of patients, preventing 1 in 20 from undergoing needless surgery.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Neurosurgery
Background:
- Carotid endarterectomy is a surgical procedure to remove plaque from carotid arteries.
- Preoperative assessment is crucial to determine the necessity of surgery.
- Duplex ultrasound is a non-invasive imaging technique used to assess blood flow and vessel structure.
Purpose of the Study:
- To evaluate the effectiveness of preoperative duplex ultrasound in preventing unnecessary carotid endarterectomy.
- To determine the rate of avoided surgeries due to duplex findings.
Main Methods:
- A 7-year prospective study (1997-2003) of 475 patients scheduled for carotid endarterectomy.
- Analysis of vascular departmental records and patient notes for cancellations.
- Review of duplex ultrasound and angiogram results for patients with suspected or confirmed occlusions.
Main Results:
- 36 out of 475 patients (7.6%) had their carotid endarterectomy cancelled.
- Duplex ultrasound identified occlusions in 24 patients (5%), preventing unnecessary surgery.
- Angiography confirmed occlusion or severe stenosis in 13 of the 16 patients with suspicious duplex findings.
Conclusions:
- Preoperative duplex ultrasound is effective in identifying carotid artery occlusions.
- Routine duplex ultrasound on admission avoids unnecessary carotid endarterectomy in approximately 5% of scheduled patients.
- This policy optimizes surgical resource allocation and patient care.
Objectives:
Our unit policy is to duplex on admission all patients undergoing carotid endarterectomy to confirm patency. The aim of this study was to evaluate whether this had led to avoidance of unnecessary carotid surgery in a significant number of patients.
Methods:
Over a 7-year period from January 1997 to December 2003, a total of 475 patients were scheduled for carotid endarterectomy. Of these, 439 patients subsequently underwent carotid endarterectomy. These data were obtained from prospectively collected vascular departmental records and we also hand searched notes of the 36 cancelled patients.
Results:
There were a total of 36 cancellations for various reasons. Of these, 8 were clearly occluded on duplex. A further 16 were highly suspicious of occlusion on duplex and thus surgery was deferred and selective angiography was undertaken. Of these 9 were confirmed to be occluded on angiogram and a further 4 had severe stenoses or virtual occlusion, 3 patients had a distal internal carotid artery occlusion. Thus a total of 24 patients had an occlusion either diagnosed directly on duplex or because of suspicion on duplex. Unnecessary carotid surgery was avoided in 24 of 475 (5%) of patients.
Conclusion:
This study shows that a preoperative duplex on admission for surgery results in 1 of 20 patients avoiding unnecessary carotid surgery.
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