title: Carotid endarterectomy in the elderly: risk factors, intraoperative carotid hemodynamics and short-term complications: a UK tertiary center retrospective analysis.
abstract: This retrospective analysis aims to demonstrate the safety of carotid endarterectomy (CE) in patients >75 years with particular attention paid to intraoperative hemodynamics. Four hundred and ninety-six consecutive patients with >70% symptomatic and asymptomatic stenosis who underwent CE were prospectively assessed and divided into those <75 years (n = 408; mean 64 years) and those >75 years (n = 88; mean 78 years). Associated risk factors, hemodynamic parameters, surgical techniques and 30-day perioperative complications were compared. Carotid artery stump pressures of <25 mmHg (13 versus 29%) and middle cerebral artery velocities of <20 cm/sec (46 versus 29%) were more common in those >75 years (P = 0.0001 and P <0.005, respectively). However, there was no difference in the frequency of intraluminal shunt (34% in both groups) or synthetic patch usage (primary patching: 12.5%, older group versus 11%, younger group; secondary patching: 34% in both groups), and no difference in the combined 30-day stroke and death rates (3.4%, >75 years versus 1.1%, <75 years; P = 0.425). CE in this cohort of patients >75 years was not associated with increased morbidity or mortality. Altered intraoperative hemodynamics were not associated with increased use of shunting or patching. This analysis supports CE as a safe procedure in the elderly.
authors.affiliation: Department of Ultrasonic Angiology hazim.sadideen@doctors.org.uk.
authors.forename: H
authors.initials: H
authors.lastname: Sadideen
authors.affiliation: Department of Ultrasonic Angiology.
authors.forename: D R
authors.initials: DR
authors.lastname: Thomson
authors.affiliation: Department of Elderly Care Medicine.
authors.forename: R R
authors.initials: RR
authors.lastname: Lewis
authors.affiliation: Department of Ultrasonic Angiology.
authors.forename: T S
authors.initials: TS
authors.lastname: Padayachee
authors.affiliation: Department of Vascular Surgery, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: P R
authors.initials: PR
authors.lastname: Taylor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D058070:Asymptomatic Diseases; D001783:Blood Flow Velocity; D002339:Carotid Arteries / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D016208:Databases, Factual; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: carotid endarterectomy; complications; elderly; intraoperative hemodynamics; stroke