title: Long-Term Effect of the Type of Carotid Endarterectomy on Blood Pressure.
abstract: BACKGROUND
  The dissection of the carotid sinus nerve in eversion carotid endarterectomy (eCEA) has been hypothesized to cause an increase in postoperative blood pressure (BP). The objective of this study is to evaluate the effect of eCEA on BP and changes in BP medications over the course of year-long follow-up after eCEA compared with longitudinal incision carotid endarterectomy patch angioplasty (pCEA).
  
  
  METHODS
  A retrospective review of patients who underwent CEA between July 1, 2009 and June 30, 2014 in the Vascular Surgery Department at The University of Iowa Hospital and Clinics was conducted. Demographics, comorbidities, BP, and number, dosage, and type of antihypertensive medications were collected preoperatively, at 30 days, and at 12 months. The differences in BP and medications between pCEA and eCEA patients were compared. Demographic data and comorbidities were compared using t-tests and chi-squared analysis. Differences in BP and medication dosages were analyzed using multivariate analysis of variance.
  
  
  RESULTS
  In total, 363 CEA procedures were performed during the study period, of which 275 procedures were included in the final analysis. Thirty percent of the patients underwent eCEA. Fifty-four percent of the patients who underwent eCEA and 60% of the patients who underwent pCEA were symptomatic. Thirty-day mortality was 1.4% and 12-month mortality was 6.4% for the entire population. No postoperative neurologic deficits, including stroke, were observed. Analysis of BP did not yield a significant difference among preoperative, 30-day, and 12-month follow-up measurements (P = 0.893). There was no significant change to the number and total daily dose of BP medications preoperatively, at 30 days, or at 12 months.
  
  
  CONCLUSIONS
  There is no statistical difference in mortality, morbidity, and patency rates at 30 days and 12 months between pCEA and eCEA. eCEA is also not associated with long-term BP changes compared with pCEA.
authors.affiliation: Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA. Electronic address: maen-aboulhosn@uiowa.edu.
authors.forename: Maen Aboul
authors.initials: MA
authors.lastname: Hosn
authors.affiliation: Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Brian
authors.initials: B
authors.lastname: Adams
authors.affiliation: Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Mark
authors.initials: M
authors.lastname: Pederson
authors.affiliation: Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kresowik
authors.affiliation: Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pascarella
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007484:Iowa; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000959:Antihypertensive Agents