[Postoperative blood pressure alterations after carotid endarterectomy : Implications of different reconstruction
J A Celi de la Torre1, D A Skrypnik2, R A Vinogradov3
1Humanmedizin, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland.
Insights
Postoperative blood pressure changes after carotid endarterectomy (CEA) depend on the surgical technique. Conventional CEA with patch plasty (C-CEA) and carotid sinus-preserving eversion CEA (SP-E-CEA) show more favorable blood pressure outcomes than eversion CEA (E-CEA).
Area of Science:
- Vascular Surgery
- Cardiovascular Physiology
- Surgical Outcomes
Background:
- Postoperative blood pressure fluctuations after carotid endarterectomy (CEA) increase risks.
- Understanding the impact of different CEA techniques on hemodynamics is crucial.
Purpose of the Study:
- To compare the effects of conventional CEA with patch plasty (C-CEA), eversion CEA (E-CEA), and carotid sinus-preserving eversion CEA (SP-E-CEA) on postoperative hemodynamics.
- To review current scientific literature on these surgical techniques.
Main Methods:
- Systematic review of PubMed (NLM) database from 1974 to 2017.
- Inclusion of 34 relevant papers and 1 meta-analysis, excluding case reports.
Main Results:
- Eversion CEA (E-CEA) was associated with impaired baroreceptor function and increased vasodilator need post-surgery.
- Conventional CEA with patch plasty (C-CEA) and SP-E-CEA demonstrated a more favorable impact on postoperative blood pressure.
Conclusions:
- The choice of carotid endarterectomy technique influences postoperative blood pressure regulation.
- Close blood pressure monitoring is recommended post-surgery.
- Further research is needed to establish SP-E-CEA as a viable alternative to E-CEA.
Background:
Postoperative blood pressure alterations after carotid endarterectomy (CEA) are associated with an increased risk of morbidity and mortality.
Objective:
To outline the influence of the two commonly used surgical reconstruction techniques, conventional CEA with patch plasty (C-CEA) and eversion CEA (E-CEA), as well as the innovative carotid sinus-preserving eversion CEA (SP-E-CEA) technique on postoperative hemodynamics, taking the current scientific knowledge into consideration.
Methods:
Assessment of the current clinical and scientific evidence on each operative technique found in the PubMed (NLM) database ranging from 1974 to 2017, excluding case reports.
Results:
A total of 34 relevant papers as well as 1 meta-analysis, which scientifically dealt with the described topic were identified. The results of the studies and the meta-analysis showed that E‑CEA correlates with an impairment of local baroreceptor functions as well as with an elevated need for vasodilators in the early postoperative phase, whereas C‑CEA and SP-E-CEA seem to have a more favorable effect on the postoperative blood pressure.
Conclusion:
The CEA technique influences the postoperative blood pressure regulation, irrespective of the operative technique used. Accordingly, close blood pressure monitoring is recommended at least during the postoperative hospital stay. Further studies are mandatory to evaluate the importance of SP-E-CEA as an alternative to the classical E‑CEA.
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