Advanced Search

Home > Journals > Italian Journal of Vascular and Endovascular Surgery > Past Issues > Giornale Italiano di Chirurgia Vascolare 2001 September;8(3) > Giornale Italiano di Chirurgia Vascolare 2001 September;8(3):217-29

ISSUES AND ARTICLES   MOST READ   eTOC

CURRENT ISSUEITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
Indexed/Abstracted in: EMBASE, Scopus

 

Giornale Italiano di Chirurgia Vascolare 2001 September;8(3):217-29

 ORIGINAL ARTICLES

Routinely delayed shunt insertion during carotid endarterectomy

Grego F., Lepidi S., Damiani N., Zaramella M., Antonello M., Bonvini S., Deriu G. P.

From the Azienda Ospedaliera, Padua Department of Vascular Surgery University of Padua, Padua, Italy (Chief: Prof. G. P. Deriu)

Background. The aim of ­this ­study is to ver­i­fy wheth­er and how ­long ­shunt inser­tion dur­ing carot­id endar­te­rec­to­my (CEA) can be safe­ly ­delayed to per­mit ­plaque remov­al and ­ensure cere­bral per­fu­sion dur­ing the fur­ther ­time-con­sum­ing maneu­vers of CEA (peel­ing, ­patch angio­plas­ty).
Methods. From July 1990 to December 1999, 1067 ­patients under­went 1176 CEAs ­under gen­er­al anes­the­sia ­with con­tin­u­ous EEG mon­i­tor­ing and ­PTFE ­patch angio­plas­ty. A Pruitt-Inahara ­shunt was rou­tine­ly insert­ed ­only ­after ath­e­ros­cle­rot­ic ­plaque remov­al.
Results. In 927 CEAs (79%) ­with EEG ­signs of cere­bral ische­mia (Group A) ­first clamp­ing ­time was 7.5±2.12 min (­range: 2-37 min). In 249 CEAs (21%) ­with EEG ­signs of cere­bral ische­mia (Group B) clamp­ing ­time was 5.12±1.44 min (­range: 3-20 min). All ­patients had nor­mal EEG sig­nals ­after ­delayed ­shunt inser­tion and reper­fu­sion. Short-­term ­results (with­in 30 ­days) ­showed a neu­ro­log­i­cal rel­e­vant com­pli­cate ­rate of 1.1%, ­with 11 ­major ­strokes and two ­lethal ­strokes. At awak­en­ing, 23 RINDs (1.9% of ­total) ­were ­observed, ­with nine record­ed in Group A (0.9%) and 14 in Group B (5.6%).
Conclusions. Under gen­er­al anes­the­sia and EEG mon­i­tor­ing, cere­bral paren­chy­ma can tol­er­ate ische­mia sec­on­dary to carot­id clamp­ing for at ­least 3.12±1.44 min with­out pro­duc­ing neu­ro­log­i­cal def­i­cits. This inter­val is ­long ­enough to per­form the ­most dif­fi­cult ­steps of CEA and ­allows ­shunt inser­tion in a ­clean oper­a­tive ­field. The ­shunt ­also per­mits com­ple­men­tary ­time-con­sum­ing ­steps ­such as ­patch angio­plas­ty, ­thus improv­ing ­both ­short and ­long-­term ­results.

language: English, Italian


FULL TEXT  REPRINTS

top of page