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[Simultaneous intervention on the carotid artery, abdominal aorta and their branches]
Insights
Simultaneous carotid endarterectomy with major vascular procedures is recommended for critical stenosis. This combined approach can improve long-term survival and reduce operative mortality in select patients.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Nephrology
Background:
- Combined coronary and carotid revascularization is established.
- The efficacy of simultaneous carotid and aortoiliac occlusive disease procedures is under discussion.
- Multivessel disease involving carotid, aortoiliac, and renal arteries presents complex therapeutic challenges.
Abstract:
A simultaneous approach to revascularization for combined coronary and carotid disease today is well accepted. The discussion about combined procedures of carotid and aortoiliac occlusive disease is still going on. We operated upon 3 patients, aged 63,56 and 65 years, who suffered from carotid, aortoiliac and renal artery disease. Main symptoms were hypertensive crisis with pulmonary edema and intermittent claudication. Dizziness, transient ischemic attacks and slight renal insufficiency were present in two, one and two patients respectively. After recompensation a simultaneous operation was performed: carotid endarterectomy with inlying shunt, reconstruction and patch-plasty of the renal arteries and implantation of a aortofemoral artery bypass graft. Postoperative complications: hypertensive crisis, low output syndrome and oliguria (1 pt.) and deep vein thrombosis (1 pt.) could be treated conservatively. 10 and 12 months later the patients are symptom-free except one, who suffers from angina NYHA II. In conclusion we recommend carotid endarterectomy simultaneously with any major vascular procedure, if a critical stenosis is visualized to improve long-term survival in addition to reducing operative mortality.