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Use of Intraoperative Duplex Ultrasonography and Routine Patch Angioplasty in Patients Undergoing Carotid Endarterectomy

  • Matthias H. Seelig
    Affiliations
    Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, Fia
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  • Author Footnotes
    * Dr Seelig is now with the General Hospital Ludwigshafen, Heidelberg, Germany. Dr Klingler is now with the University of Innsbruck, Innsbruck, Austria.
    Paul J. Klingler
    Footnotes
    * Dr Seelig is now with the General Hospital Ludwigshafen, Heidelberg, Germany. Dr Klingler is now with the University of Innsbruck, Innsbruck, Austria.
    Affiliations
    Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, Fia
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  • W. Andrew Oldenburg
    Correspondence
    Address reprint requests and correspondence to W. Andrew Oldenburg, MD, Department of Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Rd, Jacksonville, FL 32224
    Affiliations
    Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, Fia
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  • Elizabeth J. Atkinson
    Affiliations
    Section of Biostatistics, Mayo Clinic Rochester, Rochester, Minn
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  • Author Footnotes
    * Dr Seelig is now with the General Hospital Ludwigshafen, Heidelberg, Germany. Dr Klingler is now with the University of Innsbruck, Innsbruck, Austria.

      Objectives

      To determine the value of routine patch angioplasty and intraoperative duplex ultrasonography (US) during carotid endarterectomy (CEA) for high-grade internal carotid artery stenosis.

      Patients and Methods

      The charts of 102 consecutive patients who underwent CEA with routine patching and intraoperative duplex US for treatment of high-grade carotid stenosis between June 1991 and January 1997 were reviewed retrospectively. Recurrent stenosis was defined as a narrowing in the common or internal carotid artery of more than 40%.

      Results

      Of 102 patients, 65 (63.7%) were men, and 37 (36.3%) were women (mean age, 72.4 years). Thirteen patients (12.7%) had bilateral CEAs. Intraoperative duplex US revealed abnormalities during 29 (25.2%) of 115 CEAs; 14 abnormalities (12.2%) were major and underwent immediate revision. No perioperative neurologic events or deaths occurred. Mean length of follow-up was 21.3 months (range, 1.3-72.6 months). Late neurologic events occurred in 2 patients, and 5 patients died during follow-up. All neurologic events and deaths were unrelated to the patients’ carotid surgery. Twelve patients (11.8%) developed moderate restenosis (40%-69%). In 4 of these patients restenosis resolved during further follow-up. No patient developed severe recurrent carotid stenosis.

      Conclusion

      Morbidity and mortality following CEA with routine patch angioplasty and intraoperative duplex US appear to be low. Routine intraoperative duplex US detects correctable technical problems that subsequently lead to a low incidence of symptomatic stenosis. The low incidence of recurrent stenosis suggests that routine postoperative follow-up may not be necessary or cost-effective unless the patient has symptoms or a contralateral stenosis.

      Abbreviations:

      CCA (common carotid artery), CEA (carotid endarterectomy), ECA (external carotid artery), ICA (internal carotid artery), US (ultrasonography)
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      REFERENCES

        • Executive Committee for the Asymptomatic Carotid Atherosclerosis Study
        Endartercclomy for asymptomatic carotid artery stenosis.
        JAMA. 1995; 273: 1421-1428
        • North American Symptomatic Carotid Endarlerectomy Trial Collaborators
        Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
        JV EnglJ Med. 1991; 325: 445-453
        • Ricotta JJ
        • O'Brien MS
        • DcWeese JA
        Natural history of recurrent and residual stenosis after carotid endarterectomy: implications for postoperative surveillance and surgical management.
        Surgery. 1992; 112: 656-661
        • Nitzberg RS
        • Mackey WC
        • Prendiville E
        • et al.
        Long-lerm follow-up of patients operated on for recurrent carotid stenosis.
        J Vase Surg. 1991; 13: 121-126
        • Kinney EV
        • Seabrook GR
        • Kinney LY
        • Bandyk DF
        • Towne JB
        The importance of intraoperative detection of residual flow abnormalities after carotid artery endarterectomy.
        J Vase Surg. 1993; 17: 9I2-922
        • Baker WH
        • Koustas G
        • Burke K
        • Littooy FN
        • Greisler HP
        Intra-operativc duplex scanning and late carotid artery stenosis.
        J Vase Surg. 1994; 19: 829-832
        • Carballo RE
        • Towne JB
        • Seabrook GR
        • Freischlag JA
        • Cambria RA
        An outcome analysis of carotid endarterectomy: the incidence and natural history of recurrent stenosis.
        J Vase Surg. 1996; 23: 749-753
        • Gelabert HA
        • el-Massry S
        • Moore WS
        Carotid endarterectomy with primary closure does nol adversely affect the rale of recurrent stenosis.
        Arch Surg. 1994; 129: 648-654
        • AbuRahma AF
        • Robinson PA
        • Saiedy S
        • Khan JH
        • Boland JP
        Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: long-term follow-up.
        J Vase Surg. 1998; 27: 222-232
        • Myers SI
        • Valentine RJ
        • Chervu A
        • Bowers BL
        • Clagett GP
        Saphenous vein patch versus primary closure for carotid endarterectomy: long-term assessment of a randomized prospective study.
        J Vase Surg. 1994; 19: 15-22
        • Katz D
        • Snyder SO
        • Gandhi RH
        • et al.
        Long-term follow-up for recurrent stenosis: a prospective randomized study of expanded polytelrafluoroethylene patch angioplasty versus primary closure after carotid endarterectomy.
        J Vase Surg. 1994; 19: 198-203
        • Rosenthal D
        • Archie Jr, JP
        • Garcia-Rinaldi R
        • et al.
        Carotid patch angioplasty: immediate and long-term results.
        J Vase Surg. 1990; 12: 326-333
        • Bandyk DF
        • Mills JL
        • Gahtan V
        • Esses GE
        Intraoperative duplex scanning of arterial reconstructions: fate of repaired and unrepaired defects.
        J Vase Surg. 1994; 20: 426-432
        • Walker RA
        • Fox AD
        • Magee TR
        • Horrocks M
        Intraoperaiivc duplex scanning as a means of quality control during carotid endarterectomy.
        Eur J Vase Endovasc Surg. 1996; 11: 364-367
        • AbuRahma AF
        • Khan JH
        • Robinson PA
        • et al.
        Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoro-ethylene: perioperative (30-day) results.
        J Vase Surg. 1996; 24: 998-1006
        • De Letter JAM
        • Moll FL
        • Welten RJT
        • et al.
        Benefits of carotid patching: a prospective randomized study with long-term follow-up.
        Ann Vase Surg. 1994; 8: 54-58
        • Papanicolaou G
        • Toms C
        • Yellin AE
        • Weaver FA
        Relationship between intraoperative color-flow duplex findings and early re-stenosis after carotid endarterectomy: a preliminary report.
        J Vase Surg. 1996; 24: 588-595
        • Bandyk DF
        • Kaebnick HW
        • Adams MB
        • Towne JB
        Turbulence occurring after carotid bifurcation endarterectomy: a harbinger of residual and recurrent carotid stenosis.
        J Vase Surg. 1988; 7: 261-274
        • Ascer E
        • Gennaro M
        • Pollina RM
        • et al.
        The natural history of the external carotid artery after carotid endarterectomy: implications for management.
        J Vase Surg. 1996; 23: 582-585
        • Moore WS
        • Martello JY
        • Quinones-Baldrich WJ
        • Ahn SS
        Etio-logic importance of the intimai flap of the external carotid artery in the development of postcarotid endarterectomy stroke.
        Stroke. 1990; 21: 1497-1502
        • Countee RW
        • Vijayanathan T
        • Wu SZ
        External carotid occlusion as a cause of recurrent ischemia after carotid endarterectomy.
        Neurosurgery. 1982; 11: 518-521
        • Ouriel K
        • Green RM
        Appropriate frequency of carotid duplex testing following carotid endarterectomy.
        Am J Surg. 1995; 170: 144-147
        • Naylor AR
        • John T
        • Howlett J
        • Gillespie I
        • Allan P
        • Ruckley CV
        Surveillance imaging of the operated artery does not alter clinical outcome following carotid endarterectomy.
        Br J Surg. 1996; 83: 522-526
        • Mattos MA
        • van Bemmelen PS
        • Barkmeier LD
        • Hodgson KJ
        • Ramsey DE
        • Sumner DS
        Routine surveillance after carotid endarterectomy: does it affect clinical management?.
        J Vase Surg. 1993; 17: 819-830
        • Golledge J
        • Cuming R
        • Ellis M
        • Beattie DK
        • Davies AH
        • Greenhalgh RM
        Clinical follow-up rather than duplex surveillance after carotid endarterectomy.
        J Vasc Surg. 1997; 25: 55-63

      Linked Article

      • Correction
        Mayo Clinic ProceedingsVol. 74Issue 10
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          In the article by Seelig et al entitled “Use of Intraoperative Duplex Ultrasonography and Routine Patch Angioplasty in Patients Undergoing Carotid Endarterectomy,” published in the September 1999 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 1999;74:870–876), the byline was incorrect. The correct authorship of the article is as follows: Matthias H. Seelig, MD; W. Andrew Oldenburg, MD; Arun Chowla, MD; and Elizabeth J. Atkinson, MS. Dr Chowla is with the Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, Fla.
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