The practice of carotid endarterectomy in Australasia

Carotid endarterectomy (CEA) is a frequently performed surgical procedure and there are variations in the preoperative, operative and postoperative management related to this operation.

Questionnaires were sent to all 191 members of the Division of Vascular Surgery, Royal Australasian College of Surgeons, and the Australasian Chapter of the International Society of Cardiovascular Surgery.

The questionnaire was returned by 179 surgeons (94%). One hundred and fifty-nine were vascular surgeons, of whom 139 perform CEA. Most surgeons reported performing more CEA than 5 years previously. Surgery for asymptomatic carotid stenosis was performed by 78% of surgeons at the time of the survey. Routine carotid angiography is performed pre-operatively for symptomatic patients by 61% of surgeons and for asymptomatic patients by 56%. Intra-operative shunting is used routinely by 37% of surgeons, selectively by 58% and never by 5%. Arteriotomy patch closure is performed routinely by 16%, usually by 30%, rarely by 52% and never by 3%. The favoured patch material is Dacron 39%, PTFE 19%, ankle long saphenous vein (LSV) 22%, thigh LSV 18% or other materials 2%. Compared to their practice 5 years previously, arterial patch closure is used more often by 42% of surgeons, the same by 51% and less by 7%. Postoperatively, patients are nursed mainly in intensive care (34%) or a high-dependency unit (33%).

The practice of CEA by Australasian vascular surgeons reflects the recent trends reported in the world literature. Most Australasian surgeons perform CEA for asymptomatic disease. Forty per cent are performing CEA on the basis of duplex scanning alone. There is a trend towards increased use of patch closure. Most patients are managed in intensive care or high-dependency units.