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Cervical hematoma following carotid endarterectomy is morbid and preventable: a 12-year case-controlled review
Anthony J Comerota1, Richard Difiore, Argyrios Tzilinis
1Jobst Vascular Institute, Toledo, OH, USA. anthony.comerotamd@promedica.org
Insights
Cervical hematoma (CH) after carotid endarterectomy (CEA) increases mortality and complications. Modifying pharmacotherapy, especially combined platelet inhibition and dextran, significantly reduced CH rates.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Pharmacotherapy
Background:
- Cervical hematoma (CH) is a serious complication following carotid endarterectomy (CEA).
- Understanding the factors contributing to CH is crucial for improving patient outcomes.
Purpose of the Study:
- To review 12 years of CEA data to determine the impact of CH requiring operative evacuation on patient outcomes.
- To investigate the relationship between perioperative pharmacotherapy and the occurrence of CH.
Main Methods:
- A retrospective review of 2643 carotid endarterectomies (CEAs).
- Comparison of 57 cases of CH requiring operative evacuation with general patient characteristics and a case-controlled cohort for pharmacologic details.
Main Results:
- The incidence of CH increased between 1999 and 2003.
- CH was associated with increased operative mortality, neurologic complications, cardiac events, and cranial nerve injury.
- Combined platelet inhibition and dextran significantly increased CH risk; reporting these findings led to a 65% drop in CH rates.
Conclusions:
- Cervical hematoma (CH) after carotid endarterectomy (CEA) requiring evacuation is linked to higher postoperative mortality and morbidity.
- Combined platelet inhibition, dextran use, and elevated creatinine are causally associated with CH.
- Increased physician awareness and adjusted pharmacotherapy have successfully reduced CH incidence.
Objective:
Cervical hematoma (CH) following carotid endarterectomy (CEA) is a serious complication. We reviewed 12 years of CEA for CH requiring operative evacuation to determine its impact on the patient outcome and relationship to perioperative pharmacotherapy.
Methods:
A total of 2643 CEAs were reviewed. In all, 57 CHs requiring operative evacuation were compared to all the patients for general characteristics and with a case-controlled cohort group for pharmacologic details.
Results:
The occurrence of CH was stable from 1994 to 1998 and then increased from 1999 to 2003. The CH increased operative mortality, neurologic complications, adverse cardiac events, and cranial nerve injury. Combined platelet inhibition and dextran alone increased the risk of CH. The CH rate dropped by 65% after the observations were reported to the vascular surgeons.
Conclusion:
The CH following CEA requiring operative evacuation is associated with increased postoperative mortality and cardiac and neurologic morbidity. Combined platelet inhibition, use of dextran, and elevated creatinine are causally related to CH. Physician awareness and modified pharmacotherapy have decreased the problem.