Carotid eversion endarterectomy: short- and long-term results.
From January 1979 to December 1993, of 2723 carotid revascularizations performed on our service, 168 (6.2%) were isolated carotid eversion endarterectomies (CEEs) for atherosclerotic occlusive disease. Since 10 of these procedures were bilateral, there were 158 patients total (88 men and 70 women). Twenty-six (16.5%) had diabetes, 54 (34.2%) had coronary disease, and 107 (67.7%) had hypertension. The mean age was 68.9 +/- 8.9 years (range 38 and 85 years). Preoperative ischemic symptoms were hemispheric in 93 (55.4%) patients, retinal in 31 (18.4%), and vertebrobasilar in 37 (22%). They consisted of one or more strokes in 44 (26.2%) patients and one or more transient ischemic attacks in 99 (58.9%); 25 (14.9%) patients were asymptomatic. The operated lesion contained atherosclerotic stenotic plaque in all cases. The lesion was tightly stenotic (> 75%) and hemodynamically significant in 93 (55.4%) cases and irregular or ulcerated in all others. In 86 (51.2%) patients a coil or kink of the distal internal carotid artery was also present. The contralateral carotid artery was totally occluded in eight (4.7%) patients and tightly stenotic in seven (4.2%). All patients were operated on under deep general anesthesia; they were given systemic heparin and normal blood pressure was maintained. After freeing and cross-clamping of the carotid bifurcation, the end of the common carotid artery or the ostium of the internal carotid artery was sectioned. The section allowed a deep-plane endarterectomy through eversion and excellent control over the endarterectomized surface and its extremities. Since January 1989 completion arteriography has been routinely performed after CEE.(ABSTRACT TRUNCATED AT 250 WORDS)
Koskas
F
F
Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Kieffer
E
E
Bahnini
A
A
Ruotolo
C
C
Rancurel
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D003327:Coronary Disease / Q000150:complications; D048909:Diabetes Complications; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016896:Treatment Outcome