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Online ISSN 1827-1847
Crescenzi B. 1, Cirillo F. 2, Costagliola B. 3, Leonardo G. 1, Sangiuolo P. 1, De Angelis M. 1, Di Benedetto B. 1
1 Division of Vascular Surgery AORN - V. Monaldi, Naples
2 Doctorate of Research in Cardiologic and Cardiosurgical Sciences II University of Studies, Naples
3 Service of Anaesthesia and Resuscitation AO. - V. Monaldi, Naples
Background. Carotid surgery is evolving with the need for cost reduction and minimally invasive procedures well tolerated by patients.
Methods. From January 1998 to June 2000, we performed 464 carotid endarterectomies (CE) on 429 patients (319 men, 110 women; age range: 46-83 years; mean: 67±7.5 SD). Patients were assessed preoperatively by echo color-Doppler ultrasonography of the superior aortic branches and cerebral computed tomography without contrast medium. Based on findings from diagnostic imaging, carotid stenoses >70% were surgically treated. Carotid endarterectomy was carried out in local anesthesia. The technique used infiltration anesthesia deposited along the sternocleidomastoid muscle border, advancing the needle into the planes of the proposed incision. In 460 CEs (99.1%) the procedure was well tolerated; in 4 (0.9%) local anesthesia was converted to general anesthesia.
Results. Cerebral ischemia was noted immediately after clamping in 29 cases (6.25%) and after 5-8 min in 17 (3.6%). These patients received an intraluminal shunt, with rapid recovery of sensation without nerve damage in 40 cases (8.62%), whereas in 5 (1.07%), transient nerve injury resolved within several hours, and in 1 case (0.2%) embolic stroke with hemiplegia contralateral to the carotid lesion occurred. Total mortality was 1.29% and total morbidity 1.9%. Mean length of hospital stay was about 2.5 days.
Conclusions. The association of reliable preoperative diagnostic imaging with simple anesthesiology procedures reduced costs, length of hospital stay, operative stress on the patient, and permitted CE to be performed on subjects with severe multiorgan diseases.
language: English, Italian