Τίτλος:
Frequency and Significance of Maneuvers to Dissect the Distal Internal Carotid Artery During Carotid Endarterectomy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives: To describe the frequency, factors associated with, and significance of surgical dissection maneuvers of the distal internal carotid artery (ICA) during carotid endarterectomy (CEA). Methods: In this retrospective analysis of prospectively collected information in patients undergoing CEA, we recorded information on demographics, risk factors and comorbidities, dissection maneuvers of the distal ICA, other operative variables and neurological outcome measures. Results: During the period July 2008 and February 2020 inclusive, 218 consecutive patients (180 males, median age 69.5 years) underwent 240 CEAs. In 117 (48.8%) of them, CEA was performed for a symptomatic stenosis. Dissection maneuvers of the distal ICA were required in 77 cases (32.1%), including division and ligation of the sternocleidomastoid vessels in 66 cases (27.5%), mobilization of the XII cranial nerve in 69 cases (28.7%, with concomitant transection of the superior root of the ansa cervicalis in 11 cases, 4.6%) and division of the posterior belly of the digastric muscle in 8 cases (3.3%). Styloid osteotomy was not required in any case. Smoking was the single predictive factor associated with the use of an adjunctive dissection maneuver (odds ratio 2.23, p = 0.009). The use of a patch was more common in smokers (16% vs 7.1% in non-smokers, odds ratio 2.48, p = 0.05). Perioperative stroke and/or death rate was 0%, not allowing testing for associations with maneuver performance. Two patients (0.8%) developed a transient ischemic attack and 4 patients (1.7%) a cranial nerve injury (CNI), including 2 patients with recurrent laryngeal nerve palsy, diagnosed on routine laryngoscopy during planning of a contralateral CEA. There was no association between CNI and dissection of the distal ICA using an operative adjunct (p = 0.60). Conclusions: Several surgical maneuvers are often required to accomplish dissection of the distal ICA beyond the point of atherosclerotic disease. When dictated by operative findings, such maneuvers are deemed safe. © The Author(s) 2021.
Συγγραφείς:
Kakkos, S.K.
Papageorgopoulou, C.P.
Papadoulas, S.
Nikolakopoulos, K.M.
Kouri, A.
Salmas, M.
Siampalioti, A.
Zotou, A.
Ellul, J.
Tsolakis, I.
Περιοδικό:
Italian Journal of Vascular and Endovascular Surgery
Εκδότης:
SAGE Publications Inc.
Λέξεις-κλειδιά:
antidiabetic agent; atropine; beta adrenergic receptor blocking agent; glyceryl trinitrate; phenylephrine; polytetrafluoroethylene, adult; aged; angina pectoris; angioplasty; arteriotomy; Article; atherosclerosis; blood gas analysis; bradycardia; cardiovascular system examination; carotid artery disease; carotid endarterectomy; cerebral perfusion pressure; chronic kidney failure; cohort analysis; computed tomographic angiography; cranial nerve; cranial nerve injury; diabetes mellitus; digital subtraction angiography; Dissection maneuver; dyslipidemia; electrocardiogram; electroencephalography; female; general anesthesia; heart infarction; hematoma; human; hypercapnia; hypertension; hypotension; intensive care unit; internal carotid artery; internal carotid artery occlusion; laryngoscopy; length of stay; magnetic resonance angiography; major clinical study; male; mean arterial pressure; mobilization; nerve paralysis; observational study; osteotomy; oximetry; recurrent laryngeal nerve palsy; retrospective study; risk factor; smoking; stenosis; sternocleidomastoid muscle; stomach muscle; transient ischemic attack; adverse event; carotid artery obstruction; complication; diagnostic imaging; dissection; internal carotid artery; middle aged; risk assessment; transient ischemic attack; treatment outcome; vocal cord paralysis, Aged; Carotid Artery, Internal; Carotid Stenosis; Dissection; Endarterectomy, Carotid; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Smoking; Treatment Outcome; Vocal Cord Paralysis
DOI:
10.1177/1538574420985767
