Current practice of carotid endarterectomy in the UK

Rudarakanchana, Nung; Halliday, Alison; Kamugasha, D.; Grant, Robert; Waton, Sam; Horrocks, M.; Naylor, A.R.; Rudd, Anthony; Cloud, Geoffrey; Mitchell, David C.

doi:10.1002/bjs.7810

Cited by 21 publications

(20 citation statements)

References 27 publications

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“…5 The percentage of asymptomatic patients undergoing CEA in other European countries varies from <1% to 53%. 5,11 In the DACI 93% of patients had a symptomatic stenosis and 75% of these patients were treated <2 weeks after their first consultation in the hospital, with a variation of 40e93% between hospitals. The national guideline aims to treat at least 80% of symptomatic patients <2 weeks after the first consultation, consequently this leaves room for improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Besides the Scandinavian countries, in which 82.5% of patients are treated <2 weeks, most countries have logistic obstacles to treating symptomatic patients within this timeframe. 11,14 As it is known that the risk of a recurrent stroke is greatest in the first days after the index event, ideally symptomatic patients should be treated even sooner. 15 Therefore, time to intervention will remain a topic of attention and possibly the permitted timeframe will be shortened in the future.…”

Section: Discussionmentioning

confidence: 99%

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The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

Karthaus

Vahl

Kuhrij

et al. 2018

European Journal of Vascular and Endovascular Surgery

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CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

Karthaus

Vahl

Kuhrij

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…However, we know that historically there has been slow acceptance of guidelines and benchmarks set by professional societies and therefore we believe much of the variation within this group reflects the most current practice. [3, 20] Facilitators associated with improved uptake of guidelines have been identified in the process for creation of guideline content and how effectively and efficiently that content is communicated to its audience. [21] Creation of content begins with involvement of stakeholders, and also includes appropriate synthesis of evidence, clinical relevance, and implementation feasibility, including associated resources and costs.…”

Section: Discussionmentioning

confidence: 99%

Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative

Soden

Zettervall

Curran

et al. 2017

Journal of Vascular Surgery

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Introduction Prior studies on the cause and effect of surgical variation have been limited by utilization of administrative data. The Vascular Quality Initiative (VQI), a robust national clinical registry, provides anatomic and perioperative details allowing a more robust analysis of variation in surgical practice. Methods The VQI was used to identify all patients undergoing infrainguinal open bypass or endovascular intervention from 2009 to 2014. Asymptomatic patients were excluded. The 16 regional groups of the VQI were used to compare variation in patient selection, operative indication, technical approach, and process measures. χ2 analysis was used to assess for differences across regions where appropriate. Results A total of 52,373 interventions were included (31%). Of the 16145 bypasses, 5% were performed for asymptomatic disease, 26% for claudication, 56% for chronic limb threatening ischemia (CLI) (61% of these for tissue loss), and 13% for acute limb ischemia (ALI). Of the 35,338 endovascular procedures, 4% were for asymptomatic disease, 40% for claudication, 46% for CLI (73% tissue loss), and 12% for ALI. Potentially unwarranted variation included proportion of prosthetic conduit for infrapopliteal bypass in claudication (13–41%, median 29% P<.001), isolated tibial endovascular intervention for claudication (0.0–5.0%, median 3.0% P<.001), discharge on antiplatelet and statin (Bypass: 62–84%, P<.001; Endo: 63–89%, P<.001), and ultrasound guidance for percutaneous access (Claudication: range 7–60%, P<.001; CLI: 5–65%, P<.001). Notable areas needing further research with significant variation include proportion of CLI vs. claudication treated by bypass (38–71%, P < .001) and endovascular intervention (28- 63%, P < .001), and use of closure devices in percutaneous access (claudication 26–76%, P < .001; CLI 30–78%, P < .001). Conclusion Significant variation exists both in areas where evidence exists for best practice and therefore potentially unwarranted variation, and in areas of clinical ambiguity. Quality improvement efforts should be focused on reducing unwarranted variation. Further research should be directed at identifying best practice where no established guidelines and high variation exists.

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“…only one third of the physicians select to suture a patch during CEA, while almost 70% use a synthetic patch of various materials [10]. Hence, less than 10% of physicians in UK select to proceed with an eversion technique [10].…”

Section: Journal Of Vascular and Endovascular Surgery Issn 2573-4482mentioning

confidence: 99%

Carotid Endarterectomy: Which Technique Prevails?

Galyfos¹

2018

J Vasc Endovasc Surg

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For decades, carotid endarterectomy has been the golden standard for the management of severe carotid artery stenosis. However, several techniques have been proposed till date, and there has been a long-lasting debate concerning the proper method. Several research studies have been conducted not only evaluating the role of patch suturing versus that of primary carotid closure, but also comparing the advantages and disadvantages of different patch materials. Both synthetic and venous patches have been utilized, each with specific features and effects on postoperative outcomes. This editorial aims to summarize basic characteristics of each technique, current guidelines recommendations and pooled research data on this subject, and produce conclusions for everyday clinical practice.

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Current practice of carotid endarterectomy in the UK

Abstract: CEA is performed less commonly in the UK than in other European countries and probably remains underutilized in the prevention of stroke. Increasing the number of CEAs done in the UK, together with reducing surgical waiting times, could prevent more strokes.

Cited by 21 publications

References 27 publications

The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative

Carotid Endarterectomy: Which Technique Prevails?

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