Carotid arterial surgery using local anesthesia: a private practice retrospective study.

Area of Science:

• Vascular Surgery
• Neurology
• Anesthesiology

Background:

• Carotid endarterectomy is a controversial procedure due to increasing rates and reported complications.
• Patient safety concerns, particularly in the elderly and those with cardiac disease, necessitate careful consideration of surgical approaches.
• Traditional methods may involve shunts, which carry their own inherent risks.

Purpose of the Study:

• To evaluate the safety and efficacy of performing carotid endarterectomy exclusively under local anesthesia.
• To assess the feasibility of avoiding shunts during carotid endarterectomy with local anesthesia.
• To determine if local anesthesia is a preferred approach for carotid endarterectomy, especially in high-risk patients.

Main Methods:

• Carotid endarterectomies were performed exclusively under local anesthesia.
• Continuous neurologic monitoring of the patient was employed throughout the procedure.
• The use of shunts was evaluated based on intraoperative findings and patient status.

Main Results:

• Local anesthesia allowed for close evaluation of neurologic status during the procedure.
• The use of a shunt was obviated in over 80% of patients undergoing carotid endarterectomy under local anesthesia.
• Local anesthesia resulted in fewer hemodynamic changes and less stress, beneficial for patients with severe cardiac disease.

Conclusions:

• Carotid endarterectomy performed under local anesthesia is a viable and potentially safer alternative.
• This approach significantly reduces the need for shunts and their associated complications.
• Local anesthesia should be considered the preferred method for carotid endarterectomy, particularly in elderly patients and those with comorbidities.