Intraoperative duplex ultrasonography in carotid endarterectomy: the impact on indication for immediate revision and intermediate-term outcome.
BACKGROUND
Thromboembolic complications in relation to carotid endarterectomies (CEA) are frequently associated with technical errors. We analyzed prospectively the impact of intraoperative duplex ultrasonography (IODS) in CEA on immediate revision and postoperative results.


METHODS
We have observed 70 patients with 74 CEA. Indications for surgery were asymptomatic high grade stenosis (70-99%) or symptomatic stenosis of > 50%. IODS findings were rated as "relevant", "minor" or "normal". Relevant findings were immediately repaired. Peri- and postoperative neurological events were analyzed in Duplex Scans controls in a median length of follow-up of 17.3 months. Outcome of patients with "minor" findings (group A) were compared with patients having "normal" or corrected "relevant" findings (group B).


RESULTS
In 8/74 cases (11%) we found relevant findings leading to immediate revision. In 25/74 (34%) cases minor findings were detected which were not revised. In group A (n = 25, 34%) two asymptomatic occlusions and one recurrent high grade stenosis were found during follow-up. In group B (n = 49, 66%) we detected two high and two low grade stenosis. The 30 day death and stroke rate was 1.4% (n = 1).


CONCLUSIONS
IODS is a sensitive method to detect immediately pathological findings. Its correction seems to reduce the incidence of early occlusions and therefore early neurological events.
Ott
C
C
Departement of Surgery, Kantonsspital Graubünden, Chur, Switzerland.
Heller
G
G
Odermatt
M
M
Furrer
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D012086:Reoperation; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*