Factors Associated with Perioperative Complications During Carotid Endarterectomy

Asiddao, Caridad B.; Donegan, Judith H.; Whitesell, Robert C.; Kalbfleisch, John H.

doi:10.1097/00132586-198304000-00027

Cited by 44 publications

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“…HTN after CEA may result in prolonged hospital admission or, more seriously, may be associated with neurological and cardiac complications. 9,11,[15][16][17][18][19][20][21] In the present study, none of the patients with postoperative HTN requiring pharmacologic treatment had a neurological or cardiac complication.…”

Section: Discussionmentioning

confidence: 87%

“…10,11,13,14 HTN after CEA is a risk factor of cerebral hyperperfusion syndrome, postoperative stroke, death, or cardiac complications. 9,11,[15][16][17][18][19][20][21] Thus, poorly controlled HTN following CEA could increase perioperative morbidity and mortality and should be avoided. However, the influence of operative technique on postoperative blood pressure has been explored in only one earlier study.…”

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confidence: 99%

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The effect of eversion and conventional-patch technique in carotid surgery on postoperative hypertension

Demirel

Bruijnen

Attigah

et al. 2011

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 87%

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confidence: 99%

The effect of eversion and conventional-patch technique in carotid surgery on postoperative hypertension

Demirel

Bruijnen

Attigah

et al. 2011

Journal of Vascular Surgery

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“…Both analyses noted an increased perioperative complication rate in patients with clinically significant postoperative hypertension requiring IVMED treatment. Other studies have also noted higher complication rates, including postoperative neurological deterioration 7,18,19 and stroke or death 8,10 in patients with postoperative hypertension after CEA. In addition to neurological complications and death, Wong et al noted a nonsignificant statistical association between postoperative hypertension and MI in their study.…”

Section: Discussionmentioning

confidence: 91%

The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality

Tan

Eslami

Kalish

et al. 2014

Journal of Vascular Surgery

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Objective The objective of this study was to evaluate the outcomes of patients after carotid endarterectomy (CEA) who developed postoperative hypertension or hypotension requiring the administration of intravenous vasoactive medication (IVMED). Methods We examined consecutive, primary elective CEA performed by 128 surgeons within the Vascular Study Group of New England (VSGNE) database (2003-2010) and compared outcomes of patients who required postoperative IVMED to treat hyper- or hypotension with those who did not. Outcomes included perioperative death, stroke, myocardial infarction (MI), congestive heart failure (CHF), hospital length of stay, and 1-year stroke or death. Propensity score matching was performed to facilitate risk-adjusted comparisons. Multivariable regression models were used to compare the association between IVMED and outcomes in unmatched and matched samples. Factors associated with use of IVMED in postoperative hypertension and hypotension were evaluated, and predictive performance of multivariable models was examined using receiver operating characteristic (ROC) curves. Results Of 7677 elective CEAs identified, 23% received IVMED for treatment of either postoperative hypertension (11%) or hypotension (12%). Preoperative neurological symptomatic status (20%) was similar across cohorts. In the crude sample, the use of IVMED to treat postoperative hypertension was associated with increased 30-day mortality (0.7% vs 0.1%; P < .001), stroke (1.9% vs 1%; P = .018), MI (2.4% vs 0.5%; P < .001), and CHF (1.9% vs 0.5%; P < .001). The use of IVMED to treat postoperative hypotension was also associated with increased perioperative mortality (0.8% vs 0.1%; P < .001), stroke (3.2% vs 1.0%; P < .001), MI (2.7% vs 0.5%; P < .001), and CHF (1.7% vs 0.5%; P < .001), as well as 1-year death (5.1% vs 2.9%; P < .001) or stroke (4.2% vs 2.1%; P < .001). Hospital length of stay was significantly longer among patients who needed IVMED for postoperative hypertension (2.8 ± 4.7 days vs 1.7 ± 5.5 days; P < .001) and hypotension (2.8 ± 5.9 days vs 1.7 ± 5.5 days; P < .001). In multivariable analysis, IVMED for postoperative hyper-tension was associated with increased MI, stroke, or death (odds ratio, 2.6; 95% confidence interval [CI], 1.6-4.1; P < .001). Similarly, IVMED for postoperative hypotension was associated with increased MI, stroke, or death (odds ratio, 3.2; 95% CI, 2.1-5.0; P < .001), as well as increased 1-year stroke or death (hazard ratio, 1.6; 95% CI, 1.2-2.2; P = .003). Smoking, coronary artery disease, and clopidogrel (ROC, 0.59) were associated with postoperative hypertension requiring IVMED, whereas conventional endarterectomy and general anesthesia were associated with postoperative hypotension requiring IVMED (ROC, 0.58). The unitization of IVMED varied between 11% and 38% across VSGNE, and center effect did not affect outcomes. Conclusions Postoperative hypertension requiring IVMED after CEA is associated with increased perioperative mortality, stroke, and cardiac complications, whereas...

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“…Although CEA has been a standard method of treatment for carotid artery stenosis, haemodynamic instability after CEA has been linked to surgical morbidity and mortality 4,5,6,7 . CEA -induced hypotension has been demonstrated to correlate with poor outcome, as extensively described in the literature 8,9,10 .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Postprocedural Hypotension following Carotid Artery Stenting

Nonaka

Oka²,

Maeda³

et al. 1995

Rivista di Neuroradiologia

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This study is performed to investigate risk factors of hypotension in response to elective carotid stenting. Forty-four lesions of 40 consecutive patients (mean age 70.4 ± 8.2 years) were retrospectively analyzed. Easy Wall stent was applied in 15 lesions and SMART stent in 29 lesions. We investigated correlations between the occurrence rate of postoperative hypotension below 90 mmHg and persisting over three hours and findings of preoperative angiograms, ultrasonograms and clinical characteristics. Postprocedural hypotension occurred in 19 patients (47.5%) and medical treatment (intravenous administration of catecholamines) was required in eleven patients (27.5%). Although there was no permanent neurological deficits related with postprocedural hypotension, transient neurological deficits were found in three patients. Risk factors of prolonged postprocedural hypotension were statistically analyzed. On angiographic characteristics; 1) distance between the carotid bifurcation and the lesion with maximum stenosis (≦10 mm vs. >10 mm: p = 0.031), 2) type of stenosis (eccentric vs. concentric: p = 0.014) On ultrasonographic characteristics; 1) calcifications at the carotid bifurcation (present vs. absent: p<0.001). Other variables, including age and degree of stenosis, were not associated with postprocedural hypotension after carotid stenting. These angiographic and ultrasonographic variables can be used to identify patients at risk for postprocedural hypotension after carotid stenting. Such identification may help in selection of patients who will benefit from appropriate pharmacological treatment.

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Factors Associated with Perioperative Complications During Carotid Endarterectomy

Cited by 44 publications

References 0 publications

The effect of eversion and conventional-patch technique in carotid surgery on postoperative hypertension

The effect of eversion and conventional-patch technique in carotid surgery on postoperative hypertension

The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality

Risk Factors of Postprocedural Hypotension following Carotid Artery Stenting

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