Eversion Endarteriectomy of the Internal Carotid Artery

Bosse, A; Ansorg, P; Mayer, Barbara; Mulch, J

doi:10.1055/s-2007-1020002

Cited by 22 publications

(10 citation statements)

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“…However, many authors have reported an improvement in their outcome after standard CEA when they started resecting all kinks, or shortening or transversely folding all elongated ICAs. 21,25,30,31 CEE is a rapid surgical procedure. The carotid crossclamping (P ϭ .01), hemostasis (P ϭ .005), and overall surgical (P ϭ .01) times are significantly lower than for CEAP.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study on Bilateral Carotid Endarterectomy: Patching Versus Eversion

Ballotta¹,

Renon²,

Giau³

et al. 2000

Annals of Surgery

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ObjectiveTo compare the clinical outcome and restenosis incidence of patients who underwent carotid endarterectomy with patch closure (CEAP) on one side and carotid eversion endarterectomy (CEE) on the other. Summary Background DataAlthough a few investigators have compared the results of CEAP versus CEE, no reports have compared the outcome of CEAP versus CEE in the same patient. MethodsEighty-six patients were randomly selected for sequential surgical treatment involving either CEAP/CEE or CEE/CEAP. All patients underwent postoperative duplex ultrasound study and clinical follow-up at 1, 6, and 12 months and every year thereafter. Various factors were analyzed to ascertain any association with restenosis, and Kaplan-Meier analysis was used to estimate the risk of restenosis. ResultsDemographic and clinical data were similar in the CEAP and CEE groups. The selective shunting rate was statistically higher in the CEAP group. There were no perioperative deaths. Although the incidence of perioperative ipsilateral stroke was not significant, CEAP patients had a rate of combined transient ischemic attacks and strokes that approached statistical significance. The mean follow-up was 40 months. CEAP patients had a significantly higher incidence of restenosis and combined occlusive events and restenoses. KaplanMeier analysis showed that CEE had a significantly better cumulative patency rate than CEAP and that freedom from restenoses at 24 and 36 months was 87% and 83% for CEAP and 98% and 98% for CEE, respectively. ConclusionsCEE is less likely to cause perioperative neurologic complications and restenoses than CEAP. The significantly higher rate of unilateral recurrence suggests that local factors play a more important role than systemic factors in the occurrence of restenosis.Carotid endarterectomy (CEA) is one of the few surgical procedures whose efficacy has been tested with randomized controlled clinical trials. [1][2][3][4][5][6] Controversy has remained, however, concerning the best method for arterial closure after CEA to improve perioperative stroke and internal carotid artery (ICA) occlusion rates and to reduce the incidence of early and late restenosis. A few prospective randomized studies 7-14 have demonstrated that, when data on the three principal outcomes (perioperative stroke, early ICA occlusion, and restenosis Ͼ50% at 1 year) are pooled, the statistical results strongly favor patch-plasty over primary closure. Although patch reconstruction, regardless of the type of patch material used (autologous saphenous or

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Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study on Bilateral Carotid Endarterectomy: Patching Versus Eversion

Ballotta¹,

Renon²,

Giau³

et al. 2000

Annals of Surgery

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“…Bosse et al employed this technique in 60 procedures with no permanent neurologic deficits or mortality. 16 Berguer reported a series of 100 consecutive patients undergoing eversion endarterectomy with division of the ICA at the bifurcation (Type 1) or of the CCA (Type 2) with no perioperative stroke or operative mortality.&dquo; Mean follow-up was 14 mos in this series with no late restenosis reported. Koskas et al performed 168 eversion procedures with a 4.8% stroke/mortality rate .22 Mean follow-up in this series was 62 mos with patency determined by either duplex scan or arteriography at yearly intervals.…”

Section: Discussionmentioning

confidence: 97%

“…Reported symptomatic or asymptomatic restenosis rates range from 2% to 30%, but the cause of restenosis remains unknown.6-11 Once complete removal of the plaque is obtained, the restenosis may be due to recurrence of disease, neo-intimal hyperplasia or technical problems related to closure, therefore, there is support for patch angioplasty closure to prevent distal narrowing of the internal carotid artery (ICA)Y- 14 Recently, some European and North American centers have shown that eversion endarterectomy of the ICA, an alternate technique that avoids a suture line in the distal ICA, may reduce early occlusion and restenosis rates. [15][16][17][18][19][20][21][22][23][24] We have adopted this technique since 1993, and have performed eversion endarterectomy of the ICA in over 1,500 cases. In this chapter we present technical details, some limitations and our cumulative results using this technique.…”

mentioning

confidence: 99%

Technique of Eversion Carotid Endarterectomy and Contemporary Results

Shah¹,

Leather²,

Darling³

et al. 1998

Perspectives in Vascular Surgery and Endovascular Therapy

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Eversion endarterectomy (ECEA) of the carotid artery by Debakey et al. in 1959 made eversion of the internal carotid artery difficult and provided limited visualization of the end point of the endarterectomy. In this study we describe the technique of a modified ECEA and report our experience. Between May 1993 and August 1996, 1674 CEAs were performed in 1,391 patients for symptomatic disease or for asymptomatic stenosis (>70%). Preoperative evaluation was performed using duplex ultrasound, magnetic resonance angiography, and/or contrast angiography. Procedures were performed preferentially (>97%) under regional cervical block anesthesia in the awake patient. A shunt was used only for intraoperative neurologic deterioration. CEAs performed in patients combined with coronary artery bypass graft were performed under general anesthesia, a shunt was not used routinely in these patients. Data was prospectively collected in a vascular registry. Shunts were placed in 3.4% of ECEA. The operative mortality was 1.2% in the ECEA group and the stroke rate was 0.4% in the ECEA group. Similarly, occlusion rates of 0.4%. Mean follow-up was 7 months (range: 1-48). Postoperatively duplex scans were used to detect stenoses >50%. There was one restenosis (0.09%) at 15 months in the eversion group. There was one asymptomatic occlusion at five months in the ECEA group and two in the SCEA group at six and eight months. Four year cumulative patency rate was 98%. There has been no late stroke in either group on follow-up. The current method of eversion endarterectomy as outlined in our study is safe and reliable for the preservation of neurologic function.

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“…[24][25][26][27][28][29][30] The eversion technique enjoys the potential advantages of requiring less time in the operating room because of a shorter suture line as well as not requiring the implantation of a prosthetic, homograft, or vein patch, which requires an incision in the leg to obtain autologous saphenous vein. Prosthetic or homograft patches have additional associated cost and might be more susceptible to infection.…”

Section: Discussionmentioning

confidence: 99%