title: Carotid redo surgery: both safe and durable.
abstract: OBJECTIVE
  To examine the outcomes and complications of surgery for recurrent carotid stenosis.
  
  
  METHODS
  From 1974 to 2000, 1922 carotid endarterectomies were performed in our unit. A retrospective cohort analysis of these records identified 24 patients (1.2%) who underwent surgery for recurrent stenosis.
  
  
  RESULTS
  There were 13 men and 11 women in the group. Median follow up was 7.2 years (interquartile range 4.4-12.4 years). The indication for redo surgery was either symptomatic severe (80-99%) or moderate (50-79%) restenosis, or severe asymptomatic (80-99%) restenosis. Repair was performed by patch angioplasty (88%), endarterectomy alone (8%) or interposition grafting (4%). Within the 30 day perioperative period there were no deaths, no strokes (major or minor), or significant cardiac morbidity. One patient (4%) developed a permanent spinal accessory nerve deficit. Another patient (4%) required further re-intervention for recurrent disease.
  
  
  CONCLUSIONS
  Very low surgical morbidity and mortality was achieved in our unit by implementing a policy of selective re-intervention for carotid restenosis. Redo carotid endarterectomy can therefore be recommended as having no greater morbidity than primary carotid endarterectomy. Carotid angioplasty and stenting are not recommended as a routine alternative treatment.
authors: Department of Vascular Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia. rhar0052@mail.usyd.edu.au
authors: Richard A
authors: RA
authors: Harris
authors: Nicholas
authors: N
authors: Stow
authors: Charles M
authors: CM
authors: Fisher
authors: Michael L
authors: ML
authors: Neale
authors: Michael
authors: M
authors: Appleberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors