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Duplex imaging immediately prior to carotid endarterectomy
J M Laurence1, M J McCarthy, N J M London
1Department of Surgery, Leicester General Hospital, Leicester, UK.
Annals of the Royal College of Surgeons of England
|November 3, 2005
Summary
Repeating duplex ultrasound (DU) before carotid endarterectomy (CEA) is safe and changes management in 1.6% of cases. This avoids unnecessary surgery by detecting plaque changes or reduced stenosis in the carotid artery.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Duplex ultrasound (DU) is the primary imaging modality before carotid endarterectomy (CEA).
- Angiography is reserved for select cases.
- DU can be repeated without morbidity to assess carotid plaque and stenosis.
Purpose of the Study:
- To evaluate the impact of immediate pre-operative DU scans on CEA management decisions.
- To determine the incidence of changes in stenosis or plaque necessitating a change in surgical plans.
Main Methods:
- Retrospective analysis of 500 patients undergoing CEA.
- Repeat DU scan performed immediately prior to each surgery.
- Review of Vascular Surgery Audit database.
Main Results:
- Repeat DU identified 8 (1.6%) cases where CEA was no longer appropriate.
- Reasons included stenosis <70% (4 cases), internal carotid artery occlusion (3 cases), and plaque dissection (1 case).
Conclusions:
- Immediate pre-operative DU is a valuable tool for refining CEA indications.
- This practice avoids unnecessary surgeries and improves quality assurance.
- Repeat DU aids in training vascular technologists and validating DU techniques.