Determinants of outcome after carotid endarterectomy

Kucey, Daryl S; Bowyer, Beverley; Iron, Karey; Austin, Peter C.; Anderson, Geoff; Tu, Jack V.

doi:10.1016/s0741-5214(98)70031-x

Cited by 107 publications

(65 citation statements)

References 26 publications

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“…There were no complications after operations on asymptomatic patients. We agree with Kucey et al (1998) that, although we were studying a small number of patients, the most important factor in preventing complications is the experience of the surgeon and anesthesiologist. 26 One of the postoperative strokes happened during a difficult operation with bleeding and hypotension during clamping.…”

Section: -14supporting

confidence: 73%

Early and late results of carotid endarterectomy: retrospective study of 70 operations

et al. 2001

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Section: -14supporting

confidence: 73%

Early and late results of carotid endarterectomy: retrospective study of 70 operations

et al. 2001

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“…Over 70% of all primary fistulas were performed at the wrist in our series. Both age and female sex are associated with poor outcome for autologous fistulas 1,26 and in our series the cohort was elderly and with a high proportion of females. As the aim of the creation of an AVF is to allow haemodialysis, we have used successful dialysis as the main outcome in our study.…”

Section: Discussionmentioning

confidence: 50%

The impact of training on outcomes in primary vascular access surgery

Weale

Barwell²,

Chant³

et al. 2004

Ann R Coll Surg Engl

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Background: There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. Methods: The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. Results: 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). Conclusions: Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.

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“…These include female sex, recent ipsilateral hemispheric stroke, contralateral carotid artery occlusion, left-sided endarterectomy, plaque ulceration, age Ͼ75 years, systolic blood pressure Ͼ180 mm Hg, peripheral vascular disease, siphon or external carotid artery stenosis, cerebral (versus ocular) ischemia, and ipsilateral ischemic lesion on CT scan. [3][4][5][6] Microembolic signals (MES) detected by transcranial Doppler (TCD) are associated with an increased risk of stroke and new ischemic lesions on MR scans after CEA. [7][8][9][10][11][12] In our previous study, Ͼ50 MES per hour detected during the first postoperative hour was significantly associated with new ischemic neurological deficits.…”

Section: T He European Carotid Surgery Trial (Ecst) and Northmentioning

confidence: 99%

Possible Determinants of Early Microembolism After Carotid Endarterectomy

Stork

Levi

Chambers

et al. 2002

Stroke

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Background and Purpose-High numbers of microembolic signals (MES) have been associated with increased risk of postoperative stroke after carotid endarterectomy (CEA). We sought to identify factors predictive of postoperative MES. Methods-Transcranial Doppler monitoring of the ipsilateral middle cerebral artery for MES was performed for 30 minutes during the first postoperative hour in sequential patients undergoing CEA. Stepwise binomial logistic regression analysis was performed to identify preoperative and intraoperative variables that predicted the occurrence of postoperative MES. Results-We studied 141 patients (mean age, 69 years); 102 (72%) were male, and 69 (49%) had at least 1 MES (range, 1 to 118) detected in the first postoperative hour. The risk of postoperative MES was greater in women (Pϭ0.027), patients not receiving antiplatelet therapy (Pϭ0.033), and patients undergoing left-sided CEA (Pϭ0.049). Other variables such as residual stenosis seen on completion angiography and operative technique were not associated with postoperative MES. Conclusions-Postoperative MES were most likely in women, patients not receiving preoperative antiplatelet therapy, and patients who had a left CEA. Microembolism might explain why these same factors are associated with higher rates of perioperative stroke.

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Determinants of outcome after carotid endarterectomy

Cited by 107 publications

References 26 publications

Early and late results of carotid endarterectomy: retrospective study of 70 operations

Early and late results of carotid endarterectomy: retrospective study of 70 operations

The impact of training on outcomes in primary vascular access surgery

Possible Determinants of Early Microembolism After Carotid Endarterectomy

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