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Completion angiography, is it really necessary?

J J Ricotta¹, M S O'Brien-Irr

¹Division of Vascular Surgery, SUNY at Buffalo, New York, USA.

American Journal of Surgery

|August 1, 1997

Summary

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Omitting routine completion imaging after carotid endarterectomy (CEA) did not adversely affect patient outcomes. Careful surgical technique and selective imaging are sufficient for excellent results in CEA procedures.

Area of Science:

Vascular Surgery
Cerebrovascular Disease Management

Background:

Routine completion imaging after carotid endarterectomy (CEA) is debated for detecting defects and reducing complications.
Completion imaging is infrequently used in some practices, prompting an investigation into its necessity.

Purpose of the Study:

To determine if omitting routine completion imaging after CEA impacts patient outcomes.
To assess the safety and efficacy of selective imaging in CEA.

Main Methods:

Retrospective review of 229 consecutive CEAs performed between 1988 and 1996.
Duplex follow-up used to identify and classify residual carotid artery defects in 192 patients.

Main Results:

The combined stroke and death rate was 3.1% (7/229).

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Residual lesions were found in 15% (29/192) on duplex follow-up, with only 3.6% (7/192) involving the internal or common carotid arteries.

Only 3.5% (8/229) of patients received completion angiography, with 5 arteries reopened.

Conclusions:

Routine completion imaging is not essential for achieving acceptable morbidity and mortality after CEA.
Meticulous surgical technique and judicious use of selective imaging yield excellent outcomes in CEA.