Carotid endarterectomy under local anesthesia: single institutional experience

Abstract

The aim of this study is to review our experience and results of carotid endarterectomy performed under local anesthesia. We evaluated 300 patients who had undergone carotid endarterectomy with local anesthesia in our department. Surgical indication, outcome, operative technique, and complications were assessed. The patients were 58.20+/-2.76 years old and 153 (51%) were symptomatic. The perioperative course was uneventful. A shunt was inserted because of neurological deterioration in 20 patients (6.6%) with full recovery of the deficit after shunt insertion. Operative time was 52.02+/-12.86 min. There were 9 patients with postoperative neurological complications with one patient who died after 34 days. The remaining 8 patients with reversible neurological deficits recovered and were symptom-free on discharge. The mean length of hospital stay was 2.11+/-1.34 days. Carotid endarterectomy performed under local anesthesia is associated with low morbidity and mortality rates. The surgeon can assess the neurological status during the procedure and provide for a more meticulous endarterectomy. It is also associated with decreased shunt usage, decreased operative time and shorter length of hospital stay.

Bölgesel Anestezi Altında Karotis Endarterektomi ile Karotis Arter Stentin Karşılaştırmalı Sonuçları: Retrospektif Analiz ve Literatürün Gözden Geçirilmesi

“…There is also the possibility of an embolism developing because of the installation of a shunt. The rate of utilization of shunts under regional anesthesia is reported to be between 5,3% and 19,2% in the literature (19,20) . In the present study, the rate in question was higher than in the literature (45%) because of the surgeon's preference in this direction.…”

Endarterectomy and saphenous vein ‘Y’ patchplasty technique for severe carotid artery bifurcation lesion

“…Genellikle internal karotis arter çapının 5 mm veya altında olması ve primer kapatmanın gelecekte restenoza yol açabileceği düşünüldüğünde primer kapatma yerine bir patch kullanılması kabul gören bir yöntemdir [13]. Yama materyali olarak sentetik (PTFE, Dacron) ve otolog (Safen ven, juguler ven) materyaller kullanılmaktadır [14][15][16].…”

“…Karotis arter cerrahisinde endarterektomi ve patchplasti uygulanmasının perioperatif ve geç dönem restenozları önlediği ve dolayısı ile de ipsilateral stroke riskini azalttığı birçok yayında bildirilmiştir [8][9][10][11][12]. Genellikle internal karotis arter çapının 5 mm veya altında olması ve primer kapatmanın gelecekte restenoza yol açabileceği düşünüldüğünde primer kapatma yerine bir patch kullanılması kabul gören bir yöntemdir [13]. Yama materyali olarak sentetik (PTFE, Dacron) ve otolog (Safen ven, juguler ven) materyaller kullanılmaktadır [14][15][16].…”

An Alternative Surgical Procedure for a Patient with Critically Restenosed and Kinked Carotid Artery: Graft Interposition

“…Yet, in female patients primary closure technique instead of patch plasty increases the risk of restenosis [7]. …”