[Assessment of intraoperative duplex sonography during carotid endarterectomy].
BACKGROUND
Carotid endarterectomy (CEA) for prevention of strokes mandates a high amount of experience and a meticulous surgical technique. Intraoperative morphologic as well as hemodynamic monitoring of the endarterectomized arteries is rarely performed. The purpose of this study was to determine the value of intraoperative colour-coded-duplex-sonography to recognize eventual intraoperative technical problems that might result in serious cerebral damage.


METHODS
Prospective analysis of the medical data of all patients who underwent CEA for treatment of high-grade carotid stenosis between 1996 and 1999. Adequacy of the repair was assessed intraoperatively by duplexsonography.


RESULTS
Of 142 consecutive patients with a median age of 68 (43-84) years, 104 (73 %) were men and 38 (27 %) were women. 9 patients (6 %) had bilateral CEAs. Intraoperative duplexsonography revealed abnormalities during 11 (7 %) of 151 CEAs. 4 (3 %) were considered major and underwent immediate revision. There was one (0.7 %) temporary neurologic deficit (hyperperfusion syndrome) and 2 (1.3 %) cases of fatal intracerebral hemorrhage. 6 (4 %) postoperative surgical complications occurred, i. e. 3 cases of major wound hematoma (with revision) and 3 cases of temporary cranial nerve palsy. Median length of follow-up was 11 (3-35) months. No late neurologic event occurred during follow-up. 5 (3 %) patients developed asymptomatic restenosis.


CONCLUSIONS
Routine intraoperative duplexsonography is a valuable and reliable diagnostic tool to detect correctable technical problems during CEA that subsequently may lead to neurological deficits, fatal stroke or a high incidence of restenosis.
Reber
P U
PU
Abteilung für Gefässchirurgie, Klinik für Herz- und Gefässchirurgie, Inselspital, Universität Bern, Germany. Peter.Reber@neuehorizonte.ch
Ghisletta
N
N
Hakki
H
H
Zwahlen
I
I
Baumgartner
I
I
Kniemeyer
H W
HW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012039:Regional Blood Flow / Q000502:physiology; D018615:Ultrasonography, Doppler, Color