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Carotid endarterectomy in Great Britain and Ireland: trends and current practice
1Vascular Surgical Unit, Royal Infirmary, Edinburgh, UK.
Insights
Carotid endarterectomy rates in Great Britain and Ireland remain low, with most surgeons performing few procedures annually. Diagnostic techniques have shifted towards less invasive methods like duplex scanning.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Epidemiology
Background:
- Carotid endarterectomy is a critical procedure for preventing stroke.
- Understanding current surgical practices and trends is essential for optimizing patient outcomes.
- Previous surveys have established baseline data for carotid endarterectomy in the UK and Ireland.
Purpose of the Study:
- To assess the current practice patterns of carotid endarterectomy in Great Britain and Ireland.
- To identify trends in surgical volume, patient indications, and diagnostic techniques.
- To evaluate changes in intraoperative procedures since the last survey.
Main Methods:
- A postal questionnaire survey was distributed to surgeons in Great Britain and Ireland.
- The survey collected data on the number of carotid endarterectomies performed in 1989, patient indications, and diagnostic imaging modalities.
- Data were compared to a previous survey conducted 5 years prior.
Main Results:
- A high response rate (96%) was achieved, with 110 surgeons performing 1417 carotid endarterectomies in 1989.
- Transient ischemic attack and minor stroke were the primary indications; asymptomatic stenosis was rarely treated.
- A significant shift from conventional angiography to less invasive techniques like duplex scanning (used by 70% of surgeons) was observed.
- Increased use of shunts, carotid sinus nerve blockade, and patch closure during surgery was noted.
Conclusions:
- The overall number of carotid endarterectomies remains low and stable in Great Britain and Ireland.
- The increase in surgeons performing the procedure is primarily among those with low annual volumes (<10).
- The adoption of less invasive diagnostic methods signifies a modernization of pre-operative assessment for carotid endarterectomy.
Abstract:
Of 309 questionnaires on carotid endarterectomy sent to all surgeons in Great Britain and Ireland who might use this technique, 298 (96 per cent) were returned. In all, 110 (37 per cent) of 298 surgeons performed at least one carotid endarterectomy in 1989; 67 performed less than 10 and 43 greater than 10. In total, these 110 surgeons performed 1417 operations in 1989, a situation that has changed little over 5 years since the previous survey. Transient ischaemic attack and minor stroke remain the main indications for carotid endarterectomy; the operation was hardly ever performed for asymptomatic stenosis. By 1989 almost all surgeons initially assessed prospective patients using a technique less invasive than conventional angiography; duplex scanning was used 'always' or 'sometimes' by 70 per cent of surgeons. While 72 per cent of surgeons in 1984 'always' required conventional angiograms before operation, by 1989 only 21 per cent did so, most now relying on less invasive techniques. During operation there was an increasing use of shunts, carotid sinus nerve blockade and patch closure of the arteriotomy. The overall number of carotid endarterectomies performed annually in Great Britain and Ireland has remained steady over the past 5 years and is relatively low for a population of 60 millions. An increase in the number of surgeons performing the operation is almost entirely accounted for by an increase in those performing less than 10 carotid endarterectomies per year.