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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
The Journal of Cardiovascular Surgery 2015 Feb 12
Eversion carotid endarterectomy without shunt: concerning 1,385 consecutive cases
Ben Ahmed S. 1, Daniel G. 1, Benezit M. 1, Ribal J. P. 1, 2, Rosset E. 1, 2 ✉
1 CHU Clermont-Ferrand, Department of Vascular Surgery, Clermont-Ferrand, France;
2 Clermont Université, Univ Clermont1, Fac Médecine, Clermont-Ferrand, France
AIM: The aim of this study was to evaluate the perioperative results of eversion CEA (e-CEA) without shunt at 30 days.
METHODS: From January 2004 to December 2013, 1,385 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 intraarterial 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 intraarterial 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: six (0.4%) disabling and nine (0.6%) regressive stroke, three (0.2%) permanent and one (0.1%) transient ocular ischemia, and five (0.4%) transient ischemic attacks. Three (0.2%) patients had a perioperative myocardial infarction. Eleven compressive neck hematomas (0.8%) were re-operated in emergency.
CONCLUSION: 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 intraarterial shunt placement and adjuncts used to assess adequate cerebral perfusion of the ipsilateral carotid artery during e-CEA.