[Screening of carotid arteries before surgery: when does preoperative duplex ultrasound make sense?]

Carotid artery stenosis is a marker for generalized atherosclerosis with high cerebrovascular and cardiovascular morbidity and mortality rates. There is an estimated increase in prevalence of moderate stenosis for older age and male sex. Asymptomatic carotid artery stenosis is a risk factor for perioperative neurological events during general surgery. Planning of effective preoperative screening of populations at risk for asymptomatic carotid artery stenosis is best evaluated for cardiac surgery. General screening is not recommended; however, preoperative screening for asymptomatic carotid artery stenosis should be performed in high-risk patients with options for surgical or interventional treatment. These are patients with clinical signs of peripheral arterial disease and patients over 65 years old with at least one of the risk factors coronary artery disease, smoking and hypercholesterinemia. Preoperative screening in patients with carotid bruits may also be useful. Preoperative carotid artery screening may be beneficial in detecting occult carotid artery stenosis and thereby reducing perioperative neurological events.