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Published on: November 28, 2018
Perioperative blood pressure alterations after eversion and conventional carotid endarterectomy sustain in the
Serdar Demirel1, Nicolas Attigah, Hans Bruijnen
1Department of Vascular and Endovascular Surgery, University Hospital of Ruprecht-Karls, Heidelberg, Germany. Serdar.Demirel@med.uni-heidelberg.de
Objective:
Carotid endarterectomy (CEA) is associated with a profound effect on blood pressure. The aim of this study was to evaluate 24 h ambulatory blood pressure measurement (ABPM) after eversion (E-CEA) and conventional (C-CEA) endarterectomy including a midterm follow-up.
Methods:
Seventy-one patients were included in this prospective study [E-CEA (37)/C-CEA (34)]. Daytime (8 a.m. to 10 p.m.) and nighttime (10 p.m. to 8 a.m.) ABPMs were analyzed perioperatively and at midterm after a median follow-up period of 9.5 months (interquartile range (IQR) 6.4-17.8) in the E-CEA group and 11.5 months (IQR 8.3-13.6) in the C-CEA group
Results:
Patient demographics and preoperative antihypertensive regimens were similar in the two groups. Compared with baseline, ABPM decreased on postoperative day 1 in the C-CEA group (P < 0.01) but normalized by day three. By contrast, ABPM values were unchanged on day 1 in the E-CEA group but increased above baseline on day 3 (P < 0.01). E-CEA was associated with higher ABPM on day 1 (P < 0.001 daytime, P < 0.01 nighttime) and again on day 3 (P < 0.001 daytime, P < 0.01 nighttime). The use of vasodilators was more frequent in the E-CEA group, both in the recovery room (P = 0.007) and on the ward (P = 0.004). Midterm results showed no difference of average blood pressure values, but an increased maximal blood pressure (P = 0.01 daytime) and heart rate (HR) (P = 0.006 daytime) were reached in the E-CEA group and decreased HR (P = 0.01 nighttime) in the C-CEA group. Compared with baseline [(E-CEA: median (IQR) 2 (1-3); C-CEA: median (IQR) 2 (1-3)], the number of antihypertensive medications at midterm was significantly higher in the E-CEA group [(median (IQR) 3 (2-3) vs. 2 (2-3), P = 0.002)]. In both groups, no adverse cardiovascular or cerebrovascular events during follow-up could be observed.
Conclusion:
Although the initial hypertensive effect of E-CEA diminishes during midterm follow-up, patients undergoing eversion endarterectomy keep needing more antihypertensive medications and are prone to develop higher maximal blood pressure.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.