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Routine operative arteriography during carotid endarterectomy: a reassessment
Insights
Routine operative arteriography during carotid endarterectomy revealed significant defects and potential complications. This led to the discontinuation of routine use, with specific indications now outlined.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Carotid endarterectomy is a procedure to remove plaque from carotid arteries.
- Operative arteriography is sometimes used during this surgery to visualize blood flow.
- The safety and efficacy of routine operative arteriography require evaluation.
Purpose of the Study:
- To assess the incidence of defects and complications associated with operative arteriography during carotid endarterectomy.
- To determine if routine operative arteriography is beneficial in this context.
Main Methods:
- A review of 131 consecutive operative arteriograms performed with carotid endarterectomy.
- Analysis of radiographic findings and patient complications.
Main Results:
- Radiographically obstructive defects were identified in 5.3% of arteriograms.
- Complications occurred in 2.3% of patients, including one case of persistent hemiparesis.
- Defect rates varied by artery: 1.5% (common carotid), 2.3% (external carotid), 1.5% (internal carotid).
Conclusions:
- Routine operative arteriography in carotid endarterectomy is associated with significant defect rates and potential complications.
- The procedure has been discontinued at the institution for routine use.
- Specific indications for operative arteriography should be considered on a case-by-case basis.
Abstract:
One hundred and thirty-one consecutive operative arteriograms done in conjunction with carotid endarterectomy are reported. Radiographically obtrusive defects were found in 5.3% of arteriograms, with 1.5% in the common carotid artery, 2.3% in the external carotid artery, and 1.5% in the internal carotid artery. Potential complications were introduced by the operative arteriograms in 2.3% of the patients. One patient developed a persistent hemiparesis thought to be related directly to the performance of the arteriogram. On the basis of this review, routine operative arteriography as an adjunct to carotid endarterectomy has been discontinued at out institution. Specific indications for obtaining operative arteriograms are outlined.