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[Surgical management of occlusive diseases of extracranial arteries]
1Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Insights
Vascular reconstructive surgery for extracranial artery disease showed low perioperative mortality. Patchplasty may increase neurological deficit risk, while restenosis rates were similar between patchplasty and thromboendarterectomy.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Surgical Outcomes
Background:
- Extracranial arterial occlusive disease poses a significant risk for stroke.
- Vascular reconstructive surgery is a common treatment modality.
- Understanding surgical complications and long-term outcomes is crucial.
Purpose of the Study:
- To evaluate the outcomes of vascular reconstructive operations for extracranial arterial occlusive disease.
- To compare the safety and efficacy of patchplasty versus thromboendarterectomy.
- To identify factors influencing perioperative complications and restenosis.
Main Methods:
- Retrospective analysis of 257 vascular reconstructive operations in 219 patients.
- Procedures included patchplasty and thromboendarterectomy.
- Data collected on perioperative mortality, neurological deficit, intraoperative thrombus, and postoperative restenosis.
Main Results:
- Perioperative mortality was 0.78%.
- Patchplasty was associated with a higher rate of perioperative neurological deficit (33.3%) compared to thromboendarterectomy (0.8%).
- Postoperative restenosis occurred in 4.3% of cases, primarily at the carotid bifurcation, with no significant difference between techniques.
Conclusions:
- Patchplasty may be associated with an increased risk of thrombus formation and neurological deficit.
- Careful patient selection and technique are advised for patchplasty and shunt use.
- Early detection of restenosis using digital subtraction angiography is recommended.
Abstract:
In 4 years and 4 months (between Sept. 1981 and Dec. 1985) 257 vascular reconstructive operations were performed on 219 cases with an occlusive disease of the extracranial arteries at the Aggeralklinik in West Germany. Perioperative mortality was 0.78%. While in 2 cases out of 6 (33.3%), in which patchplasty was performed, patients suffered from perioperative neurological deficit, in 2 cases out of 251 (0.8%), in which thromboendarterectomy alone was performed, patients suffered from the same. This suggests that patchplasty may develop thrombus formation. Intraoperative thrombus formation in a shunt was observed in 2 cases out of 167 (1.2%). Postoperative restenosis was found in 11 cases (4.3%), in each case in carotid bifurcate lesions. Nine cases indicated intimal fibrosis histologically, namely early restenosis (within 18 months after operation), and the other 2 recurrent atherosclerosis, namely late restenosis (beyond the 18th month after operation). In the 6 cases of the former 9 reoperation by patchplasty was performed and in the latter 2 reoperation by thromboendarterectomy and patchplasty. No significant difference of restenotic rate could be observed between the cases in which patchplasty was performed and those in which thromboendarterectomy alone was performed (16.7% and 4.0%, respectively). Nor did the well-known risk factors of atherosclerosis have any significant relations with the restenotic rate. The future problems are (1) careful application of patchplasty, (2) careful use of a shunt (electroencephalographic monitoring is useful) and (3) explication of the way of recurrence and its prevention. At present, digital subtraction angiography may be useful for the early detection of postoperative restenosis.