[Intraoperative quality control in carotid surgery].
The intraoperative quality control in carotid surgery is performed by different methods: angiography, duplex-ultrasonography, transcranial Doppler ultrasonography, cw-Doppler, B-mode ultrasonography, pulsed Doppler with spectral analysis, angioscopy and flow-measurements. In Germany these measures are used only in one third of the carotid reconstructions. Especially with angiography and duplex-ultrasonography technical defects can be detected and differentiated if they were without clinical relevance like low-grade stenoses, small intima-flaps and residual plaques or needed to be reexplored. These are high-grade stenoses, acute thrombus-formations of the endarterectomised area and large intima-flaps. Abnormalities were detected in a mean of 17% of all carotid reconstructions by intraoperative control methods. In 5% severe irregularities lead to an immediate revision. Despite that there does not exist clear evidence whether the use of quality control methods reduces the perioperative neurological complication rate. It is not necessary to perform intraoperative quality control if meticulous operative technique with shunting and patch angioplasty is applied and a low perioperative complication rate is reached. For the documentation of the surgical result angiography can be recommended.
Wack
C
C
Chirurgische Klinik, Zentralklinikum Augsburg.
Wölfle
K D
KD
Loeprecht
H
H
D015901:Angiography, Digital Subtraction; D017546:Angioscopy; D019917:Blood Vessel Prosthesis Implantation; D016893:Carotid Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D002560:Cerebrovascular Circulation; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D006801:Humans; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D011786:Quality Control; D017585:Ultrasonography, Doppler, Transcranial