title: Prevention of postoperative wound haematomas and hyperperfusion following carotid endarterectomy.
abstract: OBJECTIVE
  To study the incidence of wound haematomas and hyperperfusion following carotid endarterectomy and the effect of changes in perioperative management.
  
  
  METHODS
  We undertook a prospective audit of the postoperative outcome of 300 consecutive carotid endarterectomies performed for a symptomatic stenosis of the internal carotid artery, under the care of a single consultant.
  
  
  RESULTS
  audit of the first 100 operations between 1990-93 resulted in 4 changes to clinical practice. These included the use of Dacron instead of vein because of 3 vein patch blowouts, invasive postoperative monitoring of blood pressure, and the use of intravenous beta-blockers to control hypertension, because of 4 hyperperfusion injuries. The use of 10F suction drains was discontinued, because they did not prevent 8 wound haematomas. The results of the second 100 cases between 1994-97 and the third 100 cases between 1998-2000 confirmed no further hyperperfusion injuries or patch blowouts (p =0.01 and 0.04 respectively). Larger 14F suction drains were reintroduced for the third series because of thirteen haematomas in the second series (p =0.09). Only 4 haematomas occurred in the third series ( p =0.05). The need for beta-blockers fell in the third series due to the introduction of local anaesthesia (p =0.0001).
  
  
  CONCLUSIONS
  The use of Dacron patches and postoperative control of hypertension has reduced the incidence of haemorrhage and hyperperfusion after carotid endarterectomy. Larger suction drains may also help.
authors.affiliation: Sheffield Vascular Institute, Northern General Hospital, Sheffield, S5 7AU, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Beard
authors.forename: J
authors.initials: J
authors.lastname: Mountney
authors.forename: J M
authors.initials: JM
authors.lastname: Wilkinson
authors.forename: A
authors.initials: A
authors.lastname: Payne
authors.forename: J
authors.initials: J
authors.lastname: Dicks
authors.forename: D
authors.initials: D
authors.lastname: Mitton
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D001807:Blood Vessel Prosthesis; D016893:Carotid Stenosis / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D004739:England / Q000453:epidemiology; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019990:Perioperative Care; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011475:Prosthesis Failure; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D013396:Suction / Q000379:methods
chemical_list: D000319:Adrenergic beta-Antagonists; D011093:Polyethylene Terephthalates