Comparison of Results Classical and Eversion Carotid Endarterectomy

Abstract

Introduction:Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications.Materials and Methods:It was retrospective-prospective study that involved 173 patients, with carotid stenosis, who underwent CEA, in the period of time December 2013 till December 2016. Subjects were divided into two groups in respect of technique: 90 patients were treated with E-CEA and 83 patients were treated with C-CEA.Results:Between two groups revealed a significant difference in favor of the patients from group E-CEA in the length of the surgery (92.56 ± 29.11 min. vs. 104.04 ± 18.01 min., P = 0.000), the time of clamping the carotid arteries (11.83 ± 1.81 min. vs. 23.69 ± 5:39 min., p = 0.000), the amount of post-operative drainage (25.33 ± 24.67 ml. vs. 36.14 ± 14:32 ml., p = 0.001), time spent in the intensive care unit (± 25.43 vs. 13:51 hours 34.54 ± 35.81 hours, p = 0.000), and the length of stay (4.60 ± 0.90 days vs. 5:42 ± 1.80 days, p = 0.001). In the patients of the group E-CEA, fewer number of individual postoperative complications without statistical significance: ICV (2.2% vs. 4.8%, p = 0.351), cardiac arrhythmia (2.2% vs. 4.8%, p = 0.351), transitory ischaemic attack (TIA) and cognitive disorder (2.2% vs. 7.2%, p = 0.117), mortality (1.1% vs. 1.2%, p = 0.954); and the total number of postoperative complications was significantly less in the same patients (7.77% vs. 18.7%, p = 0.042).Conclusion:The results of this study clearly indicate that operating techniques affects the specified monitored outcomes of vascular treatment of carotid arteries in favor of E-CEA technique. It would be ideally that the conclusions of this study contribute to broader use of E-CEA in treatment of carotid stenosis.

Early results of carotid endarterectomy and risk factors for in-hospital stroke

“…In studies that found ECEA and patch closure superior to the primary closure technique, no difference was reported concerning perioperative stroke (21). In light of current literature, the advantages of each surgical technique over the other is still debatable (22). There was no correlation between CCEA or ECEA techniques and stroke development in the study.…”

Does the eversion technique have a lower early postoperative stroke rate than the conventional technique in carotid endarterectomy?

“…Five of the six studies in our review are observational studies [ [3] , [4] , [5] , [6] , [7] ] and only one is a randomized trial [ 2 ]. Two studies had a large sample size of more than 1000 patients [ 2 , 3 ].…”

“… *Group 2 CCEA: 152 (0.9) patients. *P value = 0.84 *Statistically Insignificant *Large sampled size *Non-randomized retrospective analysis of prospectively collected data *1-year follow-up for about half of the patients Djedovic M et al, 2017, Medical archives journal, Bosnia and Herzegovina [ 4 ]. Retrospective-Prospective study Level 3 *Total of 173 patients.…”

Doppler is a Safe Criterion for Ensuring the Implementation of Eversion Carotid Endarterectomy

“…The technique is associated with low restenosis rates due to the ellipsoid suture line, and the appearance of a false anastomotic aneurysm is almost impossible. 2,[7][8][9][10][11] Due to the above advantages of the eversion technique, the method appears to be progressively removed from the shadow of classical endarterectomy, although it remains not widely accepted by the vascular surgery community; this may be due to tradition and a habit in performing the standard conventional endarterectomy technique, and the subsequent insufficient imparting of the ECEA technique to younger vascular surgeons. In classical endarterectomy through the elongated arteriotomy, the fixation of the distal residual atheroma through tacking sutures and the use of shunt during carotid clamping are taught with relative ease 10) ; in ECEA, a shunt cannot be easily inserted until eversion is completed, and there may be problems in accessing the distal ICA, if a distal extension of the atheroma has been underestimated before the division of the vessel.…”