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The Journal of Cardiovascular Surgery 2000 Aprile;41(2):269-73

lingua: Inglese

Carotid endarterectomy prior to major abdominal aortic surgery

Bechtel J. F. M., Bartels C., Hopstein S., Horsch S.

From the Department of Vascular Surgery Krankenhaus Porz am Rhein, Teaching Hospital University of Cologne, Cologne, Germany


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Background. Major aor­tic sur­gery car­ries a ­high ­risk of ­stroke. Carotid ­artery occlu­sive dis­ease (­CAOD) has ­been iden­ti­fied as one of the con­trib­ut­ing ­risk fac­tors. Regarding the ­long-­term pre­ven­tion of ­stroke, carot­id endar­tec­to­my (CEA) ­seems to be super­i­or to the ­best med­i­cal treat­ment in ­patients ­with ­high-­grade ­CAOD. However, the ­role of CEA ­prior to ­major aor­tic sur­gery has not ­been stud­ied.
Methods. Design: Prospective ­study, obser­va­tion­al ­design. Subjects and setting: 201 ­patients ­referred to a com­mu­nity hos­pi­tal for ­major aor­tic sur­gery. Intervention: The ­patients ­were non-inva­sive­ly ­screened by con­tin­u­ous-­wave and ­duplex Doppler ultra­so­nog­ra­phy for the pres­ence of ­CAOD. In 41 ­patients ­with angio­graph­i­cal­ly con­firmed ­high-­grade ­CAOD, CEA was per­formed ­prior to ­major aor­tic sur­gery. Main outcome measure: Combined mor­tal­ity and ­major mor­bid­ity ­from CEA and abdom­i­nal aor­tic sur­gery.
Results. There was no mor­tal­ity or mor­bid­ity relat­ed to CEA. Total per­i­op­er­a­tive mor­tal­ity relat­ed to ­major aor­tic recon­struc­tion was 3.5%. No new per­i­op­er­a­tive ­focal neu­ro­log­ic ­deficits ­occurred ­except for one ­fatal ­stroke in a ­patient in ­whom CEA had ­been ­judged not to be indi­cat­ed.
Conclusions. CEA can be per­formed safe­ly ­prior to ­major aor­tic sur­gery result­ing in excel­lent over­all neu­ro­log­ic out­come in ­patients ­with ­high-­grade ­CAOD. We pro­pose ­that ­patients sched­uled for ­major aor­tic sur­gery be ­screened for the pres­ence of high­-grade ­CAOD and ­that CEA be per­formed ­first, if indi­cat­ed accord­ing to pub­lished guide­lines.

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