title: Modified Eversion Carotid Endarterectomy (mECEA): Analysis of Clinical and Financial Outcomes.
abstract: BACKGROUND
  Several carotid endarterectomy techniques have been described, including conventional carotid endarterectomy (CCEA) performed with patch repair and eversion carotid endarterectomy (ECEA) performed with transection of the internal carotid artery. We describe our simplified technique of modified eversion carotid endarterectomy (mECEA) with longitudinal arteriotomy limited to the carotid bulb, without transection of the internal carotid artery and present our analysis of its safety, efficacy, and cost effectiveness.
  
  
  METHODS
  A retrospective review of all carotid endarterectomies performed by 3 vascular surgeons over a 3-year period was completed. About 197 mECEA were performed during the study period. Follow-up data were obtained on 77.7% of patients. A comparison was made with the contemporary literature with respect to outcomes for both CCEA and ECEA.
  
  
  RESULTS
  Between January 2012 and December 2014, a total of 197 mECEA were performed. The perioperative stroke and death rates for those undergoing mECEA was 0.5% and 0.5%, respectively. Late stroke and death rates were 3.0% and 5.1%, respectively. Perioperative rate of myocardial infarction was 1.0%. Early restenosis rates of >70% occurred in 1.4%, whereas late restenosis of >70% occurred in 2.7%. Mean operating time for those undergoing mECEA was 57.9 min. Average costs savings for mECEA compared to CCEA were $5,835.
  
  
  CONCLUSIONS
  This simplified technique has comparable outcomes to those described in the contemporary literature for both CCEA and ECEA with respect to postoperative neurologic events as well as restenosis rates. In our institution, the short mean operative times with mECEA has led to reduced resource utilization.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Sharp Grossmont Hospital Heart and Vascular Center, La Mesa, CA. Electronic address: scottm@vascularsandiego.com.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Musicant
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Sharp Grossmont Hospital Heart and Vascular Center, La Mesa, CA.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Guzzetta
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Sharp Grossmont Hospital Heart and Vascular Center, La Mesa, CA.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Terramani
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Sharp Grossmont Hospital Heart and Vascular Center, La Mesa, CA.
authors.forename: Kristina L
authors.initials: KL
authors.lastname: Greenwood
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Sharp Grossmont Hospital Heart and Vascular Center, La Mesa, CA.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Chiodo
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Sharp Grossmont Hospital Heart and Vascular Center, La Mesa, CA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Heaney
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Sharp Grossmont Hospital Heart and Vascular Center, La Mesa, CA.
authors.forename: Shelley J
authors.initials: SJ
authors.lastname: Berthiaume
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics* / Q000379:methods* / Q000401:mortality; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000209:etiology; D061646:Operative Time; D017064:Process Assessment, Health Care / Q000191:economics*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome