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Factors associated with perioperative complications during carotid endarterectomy
Insights
Poor preoperative blood pressure control and coexisting peripheral vascular disease increase hypertension risk after carotid endarterectomy. Hypertension significantly elevates the risk of both transient and permanent neurologic deficits.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Perioperative complications can impact patient outcomes.
Purpose of the Study:
- To identify preoperative and intraoperative factors associated with perioperative complications after carotid endarterectomy.
- To analyze the impact of hypertension on neurologic deficits post-surgery.
Main Methods:
- Retrospective review of 166 unilateral carotid endarterectomy cases.
- Analysis of associations between patient factors and complications like hypertension, hypotension, and neurologic deficit.
Main Results:
- No myocardial infarctions or mortality were observed.
- Postoperative hypertension was more frequent in patients with poor preoperative blood pressure control (52%) and those with peripheral vascular disease (43%).
- Neurologic deficit incidence was higher with postoperative hypertension (20%) and poorly controlled hypertension (23.8% transient deficit). Permanent neurologic deficit was more common in patients with bilateral carotid disease (8.8%).
Conclusions:
- Preoperative hypertension and peripheral vascular disease are risk factors for postoperative hypertension following carotid endarterectomy.
- Effective blood pressure management is crucial to reduce the incidence of perioperative neurologic deficits.
Abstract:
Records from 166 cases of unilateral carotid endarterectomy were reviewed to investigate the association of certain preoperative and intraoperative factors with perioperative complications including hypertension and hypotension, neurologic deficit, myocardial infarction, and mortality. No myocardial infarctions occurred and mortality was zero. Complications associated with some of the study factors included postoperative hypertension and neurologic deficit. Postoperative hypertension occurred more frequently (a) in patients with poor preoperative blood pressure (BP) control (BP greater than or equal to 170/95 torr) than in those with adequate control (BP less than 170/95 torr) or normotension (52%, 35%, and 17%, respectively, p less than 0.01) and, (b) when additional peripheral vascular disease was present (43% vs 25%, p less than 0.05). The incidence of neurologic deficit was higher when hypertension developed after surgery (20%) than when patients remained normotensive (6%) or developed hypotension (0%, p less than 0.05). Patients whose hypertension was poorly controlled had a greater incidence or transient neurologic, deficit (23.8%) than patients with controlled hypertension (2.5%) or patients with normotension (1.5%, p less than 0.01); permanent neurologic deficit occurred more frequently in those with bilateral disease on angiography than in those with unilateral disease (8.8% vs 1.2%, p less than 0.05).