Single center experience with modified eversion carotid endarterectomy

Area of Science:

• Vascular Surgery
• Cardiovascular Disease
• Surgical Techniques

Background:

• Transaortic endarterectomy is a known surgical revascularization method for atherosclerotic renovascular disease.
• Modified eversion carotid endarterectomy (MECE) adapts this technique using a longitudinal arteriotomy, simplifying the procedure and avoiding patch closure.
• MECE offers potential for easier conversion to traditional patch closure carotid endarterectomy (PCEA) if needed.

Purpose of the Study:

• To compare the safety and efficacy of modified eversion carotid endarterectomy (MECE) against traditional patch closure carotid endarterectomy (PCEA).
• To evaluate perioperative stroke, morbidity, mortality, and late restenosis rates between MECE and PCEA.

Main Methods:

• A total of 223 carotid endarterectomies (CEAs) were performed by three vascular surgeons between July 2004 and December 2008.
• Outcomes included perioperative stroke, morbidity, mortality, and restenosis rates (moderate and severe) assessed at multiple follow-up intervals.
• Data were analyzed using Student's t-test, with follow-up exceeding 12 months for all patients.

Main Results:

• Intraoperative carotid cross-clamping time was significantly shorter for MECE (29.2 minutes) compared to PCEA (52.2 minutes).
• Mortality (1.8%) and perioperative stroke (1.4%) rates were low and similar between groups; overall morbidity was 7.2%.
• Late restenosis rates were comparable between MECE (8.4%) and PCEA (6.2%), with no significant difference (p = 0.55).

Conclusions:

• Modified eversion carotid endarterectomy (MECE) presents a safer alternative to conventional carotid endarterectomy.
• MECE demonstrates a restenosis rate comparable to PCEA, with the added benefit of reduced clamping time.
• The technique obviates the need for patch closure, potentially simplifying the surgical procedure.