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

Abstract

It is concluded that E-CEA is associated with significantly higher postoperative blood pressure that persists for at least 4 days after surgery. Patients with inadequate preoperative high blood pressure control are particularly at risk after E-CEA.

Does the Technique of Carotid Endarterectomy Determine Postoperative Hypertension?

“…Both techniques have comparable low rates of morbidity and mortality. 5,6 Mehta et al 7 and D emirel et al 8 showed a higher incidence of immediate postoperative HT in patients who underwent carotid endarterectomy by eversion compared with those who were operated by conventional endarterectomy with direct closure or patch closure, with no differences in the incidence of postoperative morbidity and mortality. These were retrospective studies with results covering the first 24 hr postoperatively for the study by Mehta et al 7 and the first 4 postoperative days for the series of D emirel.…”

“…These were retrospective studies with results covering the first 24 hr postoperatively for the study by Mehta et al 7 and the first 4 postoperative days for the series of D emirel. 8 In our prospective study, we compared the peroperative and postoperative BP changes for 7 days after the surgery.…”

Altered blood pressure responses of carotid endarterectomy in patients with contralateral carotid artery lesion

“…[11,12] Even after unilateral CEA, baroreflex failure syndrome can be a potential complication for hypertensive patients with severe bilateral atherosclerotic lesions. [26] Although there are numerous risk factors associated with the development of postoperative hypertension, it is important to exercise particular caution during the dissection of the CCA in patients with bilateral baroreceptor dysfunction and reduced baroreceptor reserve in order to avoid damaging the vagus nerve and the carotid sinus and also to prevent carotid baroreceptor dysfunction.…”

“…[2] The results of the current study showed that the baroreflex dysfunction decreased significantly on postoperative day one and remained noticeably lower on postoperative day three; however, on postoperative day three, the baroreflex dysfunction also seemed to show a gradual trend (or increase) towards recovery. [26] The transience of the reduced baroreflex dysfunction might be associated with the recovery of the baroreflex dysfunction through the baroreflex apparatus located on the contralateral side, and the aortic arch a compensatory mechanisms, which may require several days for adaptation. [26] In this study, SAP, MAP and DAP were statistically significantly higher in the contralateral lesion group, compared to the patent contralateral carotid artery.…”

“…[26] The transience of the reduced baroreflex dysfunction might be associated with the recovery of the baroreflex dysfunction through the baroreflex apparatus located on the contralateral side, and the aortic arch a compensatory mechanisms, which may require several days for adaptation. [26] In this study, SAP, MAP and DAP were statistically significantly higher in the contralateral lesion group, compared to the patent contralateral carotid artery. In other words, we observed that the presence of a contralateral carotid artery lesion contributed to the baroreflex dysfunction and its associated postoperative hypertension.…”