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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2002 September;9(3):283-93

language: English, Italian

Carotid surgery in local anesthesia without preoperative angiography

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


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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.

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