title: Transverse small skin incision for carotid endarterectomy.
abstract: BACKGROUND
  The purpose of this report is to determine the feasibility of short transverse skin incision (STI < 4 cm) for eversion (EEA) and patch (PEA) endarterectomy with or without shunt by comparing it with the outcomes after long transverse skin incision (LTI 4-8 cm).
  
  
  METHODS
  Of 164 elective consecutive patients (71 ± 2.73% symptomatic) operated at one institution over 24 months, 81 were treated with STI, while 83 patients received LTI. The LTI and STI groups did not differ in terms of age, symptoms, or risk factors. EEA or PEA under locoregional (LRA) or general (GA) anesthesia were performed.
  
  
  RESULTS
  STI was associated with shorter operation times (75.19 ± 15.33 vs. 94.87 ± 41 and 99.4 ± 27.36 vs. 132.66 ± 51.32, respectively, P < 0.01) and similar clamping times (26.05 ± 5.71 vs. 26.07 ± 7.14 and 34.04 ± 9.49 vs. 42.5 ± 20.8, respectively) in the EEA and PEA groups that did not receive shunts compared with the corresponding LTI groups, and the operating room stays of the STI patients operated on GA were shorter than that of the corresponding LTI patients (181.11 ± 39.16 vs. 212.5 ± 64, P < 0.001). Nonsignificant differences were found between the corresponding STI and LTI shunt groups. No perioperative deaths occurred. STI was associated with less perioperative complications than LTI. Macroscopically nondistinguishable scar was present in 85% in the STI and 52% in the LTI groups (P < 0.001). Postoperative local irritation and paresthesia occurred similarly in the STI (11%) and LTI (14%) groups.
  
  
  CONCLUSIONS
  STIs are feasible for PEA and EEA. STIs produce significantly better cosmetic outcomes and shorter operation times than LTI and have similar rates of complication and similar incidences of local discomfort. Although no neurological consequences of using STIs for PEAs with shunts were revealed, STI should be applied with caution until sufficient patch length and long-term patency of this procedure are demonstrated.
authors.affiliation: Department of Cardiac Surgery, Heart Center Essen-Huttrop, University of Essen, Essen, Germany; Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University Clinic, Mainz, Germany; Department of Cardiothoracic Surgery, Bergmannsheil Hospital, Bochum, Germany. Electronic address: terezia.andrasi@heh.uk-essen.de.
authors.forename: Terézia B
authors.initials: TB
authors.lastname: Andrási
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University Clinic, Mainz, Germany; Department of Cardiothoracic Surgery, Bergmannsheil Hospital, Bochum, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kindler
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University Clinic, Mainz, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Dorner
authors.affiliation: Department of Cardiothoracic Surgery, Bergmannsheil Hospital, Bochum, Germany.
authors.forename: Justus
authors.initials: J
authors.lastname: Strauch
mesh_terms: D000768:Anesthesia, General; D000772:Anesthesia, Local; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D002921:Cicatrix / Q000517:prevention & control; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005858:Germany; D006801:Humans; D061646:Operative Time; D010292:Paresthesia / Q000517:prevention & control; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome