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Hemodynamic changes in Chevalier eversion versus conventional carotid endarterectomy.

M Taurino1, F Filippi1, F Persiani1

  • 1Department of Vascular Surgery, Sant'Andrea Hospital, University of Rome - "La Sapienza", Rome, Italy.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|September 24, 2014
PubMed
Summary

The Chevalier technique for eversion carotid endarterectomy (C-CEA) shows similar postoperative hypertension rates to the standard method. This suggests C-CEA offers benefits without increased hemodynamic risks, potentially preserving baroreceptor function.

Keywords:
Baroreceptor sensitivityCarotid endarterectomyChevalier techniqueEversion endarterectomyPost-endarterectomy hypertension

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Area of Science:

  • Vascular Surgery
  • Cardiovascular Medicine
  • Surgical Techniques

Background:

  • Eversion carotid endarterectomy (E-CEA), particularly the Vanmaele technique, is linked to baroreceptor reflex loss and postoperative hypertension.
  • Standard CEA techniques may also impact hemodynamic stability post-surgery.

Purpose of the Study:

  • To evaluate if the Chevalier technique for eversion carotid endarterectomy (C-CEA) alters baroreceptor function and reduces postoperative hemodynamic changes compared to standard CEA.
  • To assess the incidence of postoperative hypertension following C-CEA versus standard CEA.

Main Methods:

  • A retrospective review of 380 carotid endarterectomy patients (120 C-CEA, 260 Standard-CEA) from 2002-2012.
  • Comparison of postoperative blood pressure changes and antihypertensive medication requirements between C-CEA and Standard-CEA groups.
  • Definition of postoperative hypertension: systolic pressure >180 mm Hg or >40% rise from baseline.

Main Results:

  • No significant difference in postoperative systolic blood pressure between C-CEA and Standard-CEA groups (e.g., 134 ± 21.9 mm Hg vs. 132 ± 24.6 mm Hg in recovery).
  • Similar rates of intravenous antihypertensive drug use (11% C-CEA vs. 11.5% S-CEA) and need for dosage adjustments (4.9% vs. 4.9%).
  • No significant difference in the incidence of postoperative hypertension between the two surgical techniques.

Conclusions:

  • Chevalier eversion carotid endarterectomy (C-CEA) demonstrates comparable postoperative hypertension rates to standard CEA.
  • C-CEA may preserve baroreceptor function, offering the advantages of eversion techniques without the common penalty of postoperative hypertension.
  • The Chevalier technique is a viable option for carotid endarterectomy, potentially mitigating hemodynamic complications.