Completion angiography, is it really necessary?

Routine completion imaging after carotid endarterectomy (CEA) has been advocated by many investigators to detect and repair unsuspected defects with the goal of reducing perioperative morbidity and residual disease. However, completion imaging has been performed rarely in our practice. Our carotid registry was interrogated to determine whether omitting routine completion imaging adversely affected outcome.

A retrospective review of 229 consecutive CEAs performed by one vascular surgeon during 1988 to 1996 was completed. Duplex follow-up was used to identify persistent residual defects, which were classified as 50% to 74%, 75% to 99%, and occlusion in the common (CCA), internal (ICA), and external (ECA) arteries and was available in 192 cases.

During the study period, eight completion angiograms were performed (3.5%) and 5 arteries were reopened. Combined stroke and death rate was 3.1% (7 of 229). Duplex follow-up, available on 192 patients, showed residual lesions in 29 patients (15%), but only 7 (3.6%) involving the internal or common carotid.

Routine completion imaging is not required to achieve acceptable morbidity and mortality and minimize residual problems after CEA. Attention to operative details with selective imaging will give excellent results.