Shared quality data are associated with increased protamine use and reduced bleeding complications after carotid endarterectomy in the Vascular Study Group of New England
Reshma B. PatelPeter BeaulieuKaren HomaPhilip P. GoodneyAndrew StanleyJack L. CronenwettDavid H. StoneDaniel J. Bertges
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Objective:To prevent late cerebral icchemic stroke by canotid endarterectomy(CEA).Method:The clinical date of 18 patients with transient ischemic attack(TIA) and carotid artery stenosis who underwent CEA were reviewed.Results: After CEA,the TIA symptoms disappeared in all patients.The cerebral blood flow was improved obviously by TCD.In 6-24 months followed up:none of the patients suffered from severe complication and TIA.Conclusion:CEA possess a definite prevention for cerebral stroke in patients with severe carotid stenosis.Appropriate patients choiced selectively help to reduce the occurrence of postoperative complication.
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Reducing surgical risks to the minimum in carotid endarterectomy has become crucial, especially with the results of recent clinical trials extending indications to asymptomatic patients. The use of the saphenous vein patch graft (SVPG) has been suggested to reduce early postoperative thrombosis and cerebral infarct as well as late recurrent stenosis. However, the exact risks and complications involved in this technique are not known.During a 23-year period (1972-1994), 2888 carotid endarterectomies with SVPG for primary carotid stenosis were performed by the Neurosurgical Cerebrovascular Service at the Mayo Clinic. The data from all patients were retrospectively analyzed, emphasizing postoperative complications related to SVPG.There were five postoperative vein ruptures (0.17%), four cases of aneurysm formation, and three cases of deep infection necessitating surgical intervention. The vein patch ruptured in one male patient and four female patients (mean age, 69 yr). All ruptures occurred within 4 days of the primary operation, including two during the first 24 hours. All patients with rupture underwent emergency surgery and were found to have intact suture lines and tears in the middle of the grafts. Two patients recovered without deficits, one suffered major disability, and the other two died. Aneurysm of the patch developed in two male patients and two female patients (mean age, 71 yr). All of the patients developed painless pulsatile neck masses 1 to 9 years after the initial surgery; two also had recurrent ischemic symptoms. All of the patients with aneurysms underwent surgical correction without consequences.Although the benefit of routine use of SVPG in carotid endarterectomy is still the focus of debate, this analysis showed that its use adds a small but definite risk of serious complications related to inherent weakness of the venous tissue. If a surgeon chooses to use a patch graft, our recommendation is for use of a synthetic material rather than vein.
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