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Outcomes of Carotid Endarterectomy with Primary Closure.

Authors
  • Cheng, Ivy1
  • Vyas, Krishna S2
  • Velaga, Santhosh3
  • Davenport, Daniel L3
  • Saha, Sibu P3
  • 1 Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
  • 2 Mayo Clinic, Rochester, Minnesota.
  • 3 Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.
Type
Published Article
Journal
The International journal of angiology : official publication of the International College of Angiology, Inc
Publication Date
Jun 01, 2017
Volume
26
Issue
2
Pages
83–88
Identifiers
DOI: 10.1055/s-0037-1601053
PMID: 28566933
Source
Medline
Keywords
License
Unknown

Abstract

Carotid endarterectomy (CEA) reduces the risk of stroke in patients with internal carotid artery stenosis, although the optimal surgical technique is debated. The literature suggests that patch angioplasty reduces complication risk, although primary closure shortens cross-clamp time and eliminates complications associated with grafts. The objective of this study was to assess the complication rate after CEA with primary closure. Retrospective review of 240 consecutive patients between 2002 and 2010. Of these patients, 70% returned for follow-up visits for at least 2 or more years. Primary closure was used in all patients. The average cross-clamp time was 18 minutes. Complications in the immediate postoperative period within 30 days were as follows: stroke (n = 3; 1.1%), transient ischemic attack (TIA; n = 4; 1.5%), myocardial infarction (MI; n = 3; 1.1%), and death (n = 1; 0.4%). Short-term follow-up revealed eight patients who were found to have significant restenosis (>80%) by carotid duplex imaging. Two to ten year postoperative complication rates were as follows: stroke (n = 7; 4.2%), TIA (n = 7; 4.2%), amaurosis fugax (n = 1; 0.6%), MI (n = 8; 4.8%), and death (n = 28; 17%). Mortality was due to stroke or heart attack (n = 2; 1.2%), cancer (n = 7; 4.2%), and unknown causes (n = 19; 11%). This study presents our experience with complications after primary closure after CEA. In our experience, CEA is a safe and effective surgical means of preventing stroke in the short term. Well-designed prospective studies are needed to confirm specific patient characteristics in which primary closure and patch angioplasty are indicated.

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