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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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ORIGINAL ARTICLE  VASCULAR SECTION


The Journal of Cardiovascular Surgery 2017 August;58(4):543-50

DOI: 10.23736/S0021-9509.16.08495-0

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Eversion carotid endarterectomy without shunt: concerning 1385 consecutive cases

Sabrina BEN AHMED 1, Guillaume DANIEL 1, Marie BENEZIT 1, Jean-Pierre RIBAL 1, 2, Eugenio ROSSET 1, 2

1 Department of Vascular Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France; 2 Faculty of Medicine, Clermont University, Univ Clermont 1, Clermont-Ferrand, France


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BACKGROUND: The aim of this study was to evaluate the perioperative results of eversion carotid endarterectomy (e-CEA) without shunt at 30 days.
METHODS: From January 2004 to December 2013, 1385 e-CEAs were performed in 981 men and 404 women, for 268 hemispheric, 55 ocular and 12 oculopyramidal symptoms of carotid stenosis. The average age was 71.1 years. The contralateral internal carotid artery (ICA) was occluded in 77 cases. All e-CEAs were performed using Vanmaele technique, with blood pressure monitoring and under general anesthesia except in two cases (locoregional anesthesia alone). The need for application of an intra-arterial shunt was evaluated using visual quantification of adequate retrograde ICA pressure based on the quality of back-bleeding from the ICA. If well pulsatile, a shunt was not required. Otherwise, the systolic blood pressure was increased until a good quality ICA back-flow was obtained.
RESULTS: Freedom from intra-arterial shunt placement was 100% as a result of estimation and augmentation of arterial perfusion to demonstrate pulsatile perfusion by retrograde ICA filling. A peroperative angiography was performed in 910 cases. All surgical sites were evaluated postoperatively by Duplex imaging. The overall stroke and death rate was 1.3%. Nine (0.7%) patients died perioperatively. The 24 (1.7%) non-fatal neurologic events were ipsilateral: 6 (0.4%) disabling and 9 (0.6%) regressive stroke, 3 (0.2%) permanent and 1 (0.1%) transient ocular ischemia, and 5 (0.4%) transient ischemic attacks. Three (0.2%) patients had a perioperative myocardial infarction. Eleven compressive neck hematomas (0.8%) were reoperated in emergency.
CONCLUSIONS: E-CEA can be performed safely, as a routine technique, based on the surgeon’s evaluation of arterial back-bleeding and an increase in ipsilateral arterial perfusion with standard anesthetic procedures. Also e-CEA may be considered a cost effective method of reducing the frequency of intra-arterial shunt placement and adjuncts used to assess adequate cerebral perfusion of the ipsilateral carotid artery during e-CEA.


KEY WORDS: Carotid artery, internal - Endarterectomy, carotid - Brain ischemia

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Publication History

Issue published online: June 5, 2017
Article first published online: February 12, 2015
Manuscript accepted: February 11, 2015
Manuscript revised: January 22, 2015
Manuscript received: July 31, 2014

Cite this article as

Ben Ahmed S, Daniel G, Benezit M, Ribal JP, Rosset E. Eversion carotid endarterectomy without shunt: concerning 1385 consecutive cases. J Cardiovasc Surg 2017;58:543-50. DOI: 10.23736/S0021-9509.16.08495-0

Corresponding author e-mail

erosset@chu-clermontferrand.fr