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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 1998 June;5(2):81-95
language: English, Italian
The advantages of perioperative arteriography in carotid surgery (POAC)
Jausseran J. M., Ferdani M., Houel F., Rudondy Ph., Del Guercio L., Reggi M., Mangiacotti B.
From the Service de Chirurgie Cardio-Vasculaire Hôpital Saint-Joseph, Marseille (France)
Background. Perioperative angiography is an examination that is simple to carry out and easy to interpret for the surgeon and has thus become routine practice in vascular surgery. The objective is to decrease the incidence of postoperative neurological events and prevent restenosis.
Methods. 126 patients were operated in 1996, 101 males and 25 females, mean age 71 years (range 42-88 years). The risk factors were arterial hypertension in 56 patients (44%), heart disease in 51 patients (40%), diabetes in 18 patients (14%). Thirty-eight patients (30%) had occlusive lesions and 56 were smokers (44%). On arteriograms, all patients had stenoses superior to 60%, 65 of which were located on the right side (50.4%) and 64 on the left side (49.6%). Three patients were operated on both sides, this patency was restored to 129 carotid arteries. Before surgery 78 patients were clinically asymptomatic (stage 0 - 62%), 42 had already had a TIA and 8 fleeting amaurosis (stage I - 33%) and one patient presented with a developing TIA (stage II - 0.8%). Technically, endarterectomy was performed by eversion on 81 carotid arteries (64%), 35 had standard endarterectomy (27%) closed with a patch in 21 cases, 10 had a bypass (8%) and 3 a re-implantation (2.3%). One patient had an associated subclavian artery re-implantation and 2 patients had an associated vertebral artery re-implantation. All of the cases were submitted to a POCA check-ups.
Results. In our series, 70 patients (54%) were classified group I (normale POCA), 38 group II; including 12 stenoses and irregularities of the internal carotid artery, 22 stenoses of the external carotid artery due to intimal displacement and 8 stenoses of the primary carotid due to a « staircase effect » 15 patients in group III (12% presented with 3 tight stenoses of the internal carotid artery and 12 thrombosis of the external carotid artery. Group IV included 6 spasms of the carotid artery (4%), one of which required surgical dilation. 14 cases had to be re-operated (11%): 4 cases (3,1%) on the internal carotid (2 PTFE bypasses, 1 Dacron patch, 1 dilatation with instrumentation), 10 cases on the external carotid artery (separate endarterectomy). Two thromboses of the external carotid artery were not repaired. After revision surgery, the POCA was normal. The clinical results recorded no death, no hemiplegia, 2 regressive neurological events. The discussion analyses the advantages of POCA in preventing immediate postoperative events and later restenosis in carotid surgery. It must be stressed that the method is inoffensive and POCA is compared with ultrasound and angioscopic procedures.
Conclusions. POCA does contribute modestly to decreasing the incidence of postoperative neurological complications and later restenosis because it helps to improve surgical procedure.