Abstract
Objectives: Surgical endarterectomy is recommended as the first choice in the treatment of carotid artery stenosis. Shunt application for continuity of cerebral perfusion and closure of arteriotomy with primary repair or patchplasty during surgery is varied according to clinical experience. In this article, we are reporting our experience of primary repair without shunting. Study Design: Patients who underwent surgery for carotid artery stenosis in our clinic between 01.02.2018–30.11.018 were retrospectively analysed. Patients undergoing selective carotid artery endarterectomy were included in the study. Patients who underwent simultaneous coronary artery surgery were excluded from the study. We evaluated the perioperative and postoperative one-month follow-up of the patients. Results: Carotid endarterectomy was performed in 27 patients during the study period. The mean age of the patients was 70.8±9 and 19 70.4% were male. All operations were performed without shunt and primary repair. The mean clamping time was 6.7±0.9 minutes. In the postoperative follow-up, there were hoarseness and difficulty in swallowing in 1 patient; and hemiparesis and dysarthria in 1 patient. All symptoms were disappeared within 2 weeks. There was no mortality during the hospitalization and postoperative one-month follow-up. Conclusion: During the surgery of the carotid artery, shunting and patchplasty techniques increase the duration of surgery and manipulation. Rapid endarterectomy and primary repair of the arteriotomy might be performed safely in the experienced centers with acceptable postoperative outcomes.
References
- AbuRahma AF, Robinson PA, Saiedy S, Kahn 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 Vasc Surg 1998;27:222–34. [CrossRef]
- Al-Rawi PG, Turner CL, Waran V, Ng I, Kirkpatrick PJ. A randomized trial of synthetic patch versus direct primary closure in carotid endarterectomy. Neurosurgery 2006;59:822–9. [CrossRef]
- Piazza M, Zavatta M, Lamaina M, Taglialavoro J, Squizzato F, Grego F, Antonello M. Early Outcomes of Routine Delayed Shunting in Carotid Endarterectomy for Asymptomatic Patients. Eur J Vasc Endovasc Surg 2018;56:334–41. [CrossRef]
- Lee J, Lee S, Kim SW, Chang JW. Selective Shunting Based on Dual Monitoring with Electroencephalography and Stump Pressure for Carotid Endarterectomy. Vasc Specialist Int 2018;34:72–6. [CrossRef]
- Patel PB, LaMuraglia GM, Lancaster RT, Clouse WD, Kwolek CJ, Conrad MF, et al. Severe contralateral carotid stenosis or occlusion does not have an impact on risk of ipsilateral stroke after carotid endarterectomy. J Vasc Surg 2018;67:1744–51. [CrossRef]
- Reyhanoglu H, Asgun HF, Ozcan K, Erturk M, Durmaz I. Karotis endarterektomide karşı taraf karotis arter tıkanıklığı bir risk faktörü müdür? Turk Gogus Kalp Dama 2016;24:266–73. [CrossRef]
- Kong J, Li J, Ye Z, Fan X, Wen J, Zhang J, Liu P. Carotid Endarterectomy with Routine Shunt for Patients with Contralateral Carotid Occlusion. Ann Thorac Cardiovasc Surg 2017;23:227–32. [CrossRef]
- Bennett KM, Scarborough JE, Cox MW, Shortell CK. The impact of intraoperative shunting on early neurologic outcomes after carotid endarterectomy. J Vasc Surg 2015;61:96–102. [CrossRef]
- Goodney PP, Wallaert JB, Scali ST, Stone DH, Patel V, Shaw P, et al. Impact of practice patterns in shunt use during carotid endarterectomy with contralateral carotid occlusion. J Vasc Surg 2012;55:61–71.e1. [CrossRef]
- Rerkasem K, Rothwell PM. Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. Asian J Surg 2011;34:32–40. [CrossRef]
- Arslan C, Beşirli K, Arapi B, Göde S, Tüzün H. Karotis endarterektomide eksternal juguler ven yama plastinin orta ve uzun dönem sonuçları. Turk Gogus Kalp Dama 2016;24:51–55. [CrossRef]
- Texakalidis P, Giannopoulos S, Charisis N, Giannopoulos S, Karasavvidis T, Koullias G, Jabbour P. A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy. J Vasc Surg 2018;68:1241–56.e1. [CrossRef]
- Reina-Gutierrez T, Serrano-Hernando FJ, Sanchez-Hervas L, Ponce A, Vega de Ceniga M, Martin A. Recurrent carotid artery stenosis following endarterectomy: natural history and risk factors. Eur J Vasc Endovasc Surg 2005;29:334–41. [CrossRef]
Abstract
Amaç: Karotis arter darlıklarının tedavisinde cerrahi endarterektomi ilk tercih olarak önerilmektedir. Cerrahi sırasında serebral perfüzyonunun devamlılığı için şant uygulaması ve arteriyotominin primer ya da yama olarak kapatılması klinik tecrübelere göre farklılık göstermektedir. Bu makalede kliniğimizde uyguladığımız şant kullanılmadan, primer tamir ile ilgili sonuçlarımızı bildiriyoruz. Çalışma Planı: Kliniğimizde 01.02.2018–30.11.2018 tarihleri arasında karotis arter darlığı nedeni ile ameliyat edilen hastalar retrospektif olarak incelendi. Selektif karotis arter endarterektomi operasyonu uygulanan hastalar çalışmaya dâhil edilirken; eş zamanlı koroner arter cerrahisi operasyonu uygulanan hastalar çalışma dışı bırakıldı. Hastaların peroperatif ve postoperatif bir aylık takip sonuçları değerlendirildi. Bulgular: Çalışma periyodunda 27 hastaya karotis endarterektomi ameliyatı uygulandı. Hastaların yaş ortalaması 70,8±9 olup, 19 %70,4 ’u erkek idi. Tüm ameliyatlar şant kullanılmadan ve primer tamir ile gerçekleştirildi. Ortalama klemp süresi 6,7±0,9 dakika idi. Postoperatif dönemde bir hastada ses kısıklığı ve yutma güçlüğü; bir hastada sol kolda hemiparezi ve dizartri gelişmiş olup, semptomlar iki hafta içinde kayboldu. Hastane yatış süresince ve postoperatif bir aylık takiplerde mortaliteye rastlanmadı. Sonuç: Karotis arter endarterektomi esnasında şant uygulaması ve yama ile tamir cerrahi süresini ve manipülasyonu arttıran yöntemlerdir. Deneyimli merkezlerde hızlı bir şekilde endarterektomi uygulaması sonrası primer tamir yöntemi ile arteriyotominin tamiri kabul edilebilir postoperatif takip verileri ile güvenle uygulanabilecek bir tekniktir.
References
- AbuRahma AF, Robinson PA, Saiedy S, Kahn 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 Vasc Surg 1998;27:222–34. [CrossRef]
- Al-Rawi PG, Turner CL, Waran V, Ng I, Kirkpatrick PJ. A randomized trial of synthetic patch versus direct primary closure in carotid endarterectomy. Neurosurgery 2006;59:822–9. [CrossRef]
- Piazza M, Zavatta M, Lamaina M, Taglialavoro J, Squizzato F, Grego F, Antonello M. Early Outcomes of Routine Delayed Shunting in Carotid Endarterectomy for Asymptomatic Patients. Eur J Vasc Endovasc Surg 2018;56:334–41. [CrossRef]
- Lee J, Lee S, Kim SW, Chang JW. Selective Shunting Based on Dual Monitoring with Electroencephalography and Stump Pressure for Carotid Endarterectomy. Vasc Specialist Int 2018;34:72–6. [CrossRef]
- Patel PB, LaMuraglia GM, Lancaster RT, Clouse WD, Kwolek CJ, Conrad MF, et al. Severe contralateral carotid stenosis or occlusion does not have an impact on risk of ipsilateral stroke after carotid endarterectomy. J Vasc Surg 2018;67:1744–51. [CrossRef]
- Reyhanoglu H, Asgun HF, Ozcan K, Erturk M, Durmaz I. Karotis endarterektomide karşı taraf karotis arter tıkanıklığı bir risk faktörü müdür? Turk Gogus Kalp Dama 2016;24:266–73. [CrossRef]
- Kong J, Li J, Ye Z, Fan X, Wen J, Zhang J, Liu P. Carotid Endarterectomy with Routine Shunt for Patients with Contralateral Carotid Occlusion. Ann Thorac Cardiovasc Surg 2017;23:227–32. [CrossRef]
- Bennett KM, Scarborough JE, Cox MW, Shortell CK. The impact of intraoperative shunting on early neurologic outcomes after carotid endarterectomy. J Vasc Surg 2015;61:96–102. [CrossRef]
- Goodney PP, Wallaert JB, Scali ST, Stone DH, Patel V, Shaw P, et al. Impact of practice patterns in shunt use during carotid endarterectomy with contralateral carotid occlusion. J Vasc Surg 2012;55:61–71.e1. [CrossRef]
- Rerkasem K, Rothwell PM. Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. Asian J Surg 2011;34:32–40. [CrossRef]
- Arslan C, Beşirli K, Arapi B, Göde S, Tüzün H. Karotis endarterektomide eksternal juguler ven yama plastinin orta ve uzun dönem sonuçları. Turk Gogus Kalp Dama 2016;24:51–55. [CrossRef]
- Texakalidis P, Giannopoulos S, Charisis N, Giannopoulos S, Karasavvidis T, Koullias G, Jabbour P. A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy. J Vasc Surg 2018;68:1241–56.e1. [CrossRef]
- Reina-Gutierrez T, Serrano-Hernando FJ, Sanchez-Hervas L, Ponce A, Vega de Ceniga M, Martin A. Recurrent carotid artery stenosis following endarterectomy: natural history and risk factors. Eur J Vasc Endovasc Surg 2005;29:334–41. [CrossRef]
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 1, 2020 |
| Published in Issue | Year 2020Issue: 4 |