scholarly journals Outcomes of Carotid Endarterectomy with Primary Closure

2017 ◽  
Vol 26 (02) ◽  
pp. 083-088 ◽  
Author(s):  
Ivy Cheng ◽  
Krishna Vyas ◽  
Santhosh Velaga ◽  
Daniel Davenport ◽  
Sibu Saha
Keyword(s):  
Carotid Endarterectomy ◽  
Primary Closure ◽  
Complication Rates ◽  
Short Term ◽  
Specific Patient ◽  
Cross Clamp Time ◽  
Complication Risk ◽  
Duplex Imaging ◽  
Patch Angioplasty

AbstractCarotid endarterectomy (CEA) reduces the risk of stroke in patients with internal carotid artery stenosis, although the optimal surgical technique is debated. The literature suggests that patch angioplasty reduces complication risk, although primary closure shortens cross-clamp time and eliminates complications associated with grafts.The objective of this study was to assess the complication rate after CEA with primary closure.Retrospective review of 240 consecutive patients between 2002 and 2010. Of these patients, 70% returned for follow-up visits for at least 2 or more years.Primary closure was used in all patients. The average cross-clamp time was 18 minutes. Complications in the immediate postoperative period within 30 days were as follows: stroke (n = 3; 1.1%), transient ischemic attack (TIA; n = 4; 1.5%), myocardial infarction (MI; n = 3; 1.1%), and death (n = 1; 0.4%). Short-term follow-up revealed eight patients who were found to have significant restenosis (>80%) by carotid duplex imaging. Two to ten year postoperative complication rates were as follows: stroke (n = 7; 4.2%), TIA (n = 7; 4.2%), amaurosis fugax (n = 1; 0.6%), MI (n = 8; 4.8%), and death (n = 28; 17%). Mortality was due to stroke or heart attack (n = 2; 1.2%), cancer (n = 7; 4.2%), and unknown causes (n = 19; 11%).This study presents our experience with complications after primary closure after CEA. In our experience, CEA is a safe and effective surgical means of preventing stroke in the short term. Well-designed prospective studies are needed to confirm specific patient characteristics in which primary closure and patch angioplasty are indicated.

Carotid Endarterectomy With Primary Closure: Analysis of Outcomes and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 646-655 ◽  
Author(s):  
Georgios Zenonos ◽  
Ning Lin ◽  
Albert Kim ◽  
Jeong Eun Kim ◽  
Lance Governale ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Medical Records ◽  
Primary Closure ◽  
Medication Compliance ◽  
Senior Author ◽  
Careful Evaluation ◽  
Patch Angioplasty ◽  
St Elevation ◽  
Structured Questionnaire

Abstract Background: Despite abundant published support of patch angioplasty during carotid endarterectomy (CEA), primary closure is still widely used. The reasons underlying the persistence of primary closure are not quite evident in the literature. Objective: To present our experience with primary closure in CEA, and provide a rationale for its persistent wide use. Methods: Medical records of all patients undergoing CEA by the senior author (R.F.) were retrospectively reviewed. Follow-up was supplemented with a telephone interview and completion of a structured questionnaire. A review of the current literature was performed. Results: From 1998 to 2010, the senior author performed 111 CEAs. Average cross-clamp time was 33 ± 11 minutes. Postoperative complications included 1 non– ST-elevation myocardial infarction and 2 strokes. No deaths, cranial-nerve deficits, or acute reocclusions were observed. After a mean follow-up of 64.6 months (7170.6 case-months), there were 3 contralateral strokes and 7 deaths. There were no ipsilateral strokes or restenoses >50%. Follow-up medication compliance was 94.6% for anti-platelet agents and 91.9% for statins. The outcomes of the current study were comparable to those of the available trials comparing patch angioplasty with primary closure. A careful evaluation of the literature revealed a number of reasons potentially explaining the persistent use of patch angioplasty. Conclusion: In conjunction with contemporary medical management, primary closure during CEA may yield results comparable or superior to patch angioplasty. Advantages of primary closure include shorter cross-clamp times and elimination of graft-specific complications.

scholarly journals Comprehensive comparison of carotid endarterectomy primary closure and patch angioplasty: A single-institution experience

2022 ◽  
Vol 13 ◽  
pp. 1
Author(s):  
Nirmeen Zagzoog ◽  
Ali Elgheriani ◽  
Ahmed Attar ◽  
Radwan Takroni ◽  
Majid Aljoghaiman ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Primary Closure ◽  
Retrospective Chart Review ◽  
Single Institution ◽  
Recurrent Stenosis ◽  
Doppler Ultrasound Imaging ◽  
Patch Angioplasty ◽  
Comprehensive Comparison ◽  
Patch Closure

Background: Carotid endarterectomy (CEA) is an effective intervention for the treatment of high-grade carotid stenosis. Technical preferences exist in the operative steps including the use patch for arteriotomy closure. The goals of this study are to compare the rate of postoperative complications and the rate of recurrent stenosis between patients undergoing primary versus patch closure during CEA. Methods: Retrospective chart review was conducted for patients who underwent CEA at single institution. Vascular surgeons mainly performed patch closure technique while neurosurgeons used primary closure. Patients’ baseline characteristics as well as intraprocedural data, periprocedural complications, and postprocedural follow-up outcomes were captured. Results: Seven hundred and thirteen charts were included for review with mean age of 70.5 years (SD = 10.4) and males representing 64.2% of the cohort. About 49% of patients underwent primary closure while 364 (51%) patients underwent patch closure. Severe stenosis was more prevalent in patients receiving patch closure (94.5% vs. 89.4%; P = 0.013). The incidence of overall complications did not differ between the two procedures (odds ratio = 1.23, 95% confidence intervals = 0.82–1.85; P = 0.353) with the most common complications being neck hematoma, strokes, and TIA. Doppler ultrasound imaging at 6 months postoperative follow-up showed evidence of recurrent stenosis in 15.7% of the primary closure patients compared to 16% in patch closure cohort. Conclusion: Both primary closure and patch closure techniques seem to have similar risk profiles and are equally robust techniques to utilize for CEA procedures.

Carotid endarterectomy: neither shunting nor patching technique

2018 ◽  
Vol 26 (6) ◽  
pp. 446-450 ◽  
Author(s):  
Aram Baram ◽  
Goran Majeed ◽  
Allaa Subhi Abdel-Majeed
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Primary Closure ◽  
Artery Stenosis ◽  
Safe Procedure ◽  
Total Occlusion ◽  
Patch Angioplasty ◽  
Bilateral Carotid

Introduction The role of carotid shunting in carotid endarterectomy is controversial. Many studies have concluded that patch angioplasty is preferable to primary closure, while others found that it had no value. The aim of this study was to report the results of our first series of patients undergoing carotid endarterectomy with a non-shunting technique and primary closure of the arteriotomy. Methods From October 2014 to October 2017, 63 patients with unilateral or bilateral carotid artery stenosis underwent carotid endarterectomy. There were 48 males and 15 females, the mean age was 63.16 years, and all were symptomatic. Conventional endarterectomy was performed without a shunt in all cases. All arteriotomies were closed primarily. We analysed the early and late outcomes of this procedure with at least 18 months of follow-up. Results Diabetes was the most frequent comorbidity. Most of the patients had a history of transient ischemic attack (49.2%) or stroke (44.4%). All patients had significant (moderate to severe) carotid artery stenosis. Postoperatively, 2 (3.2%) patients developed ischemic stroke, one (1.6%) suffered hypoglossal nerve injury, and one had a postoperative cervical hematoma. During follow-up, one patient developed asymptomatic total occlusion of the endartrectomized carotid artery at 18 months. Conclusion Carotid endarterectomy without shunting is a safe procedure. The short- and longer-term outcomes are not significantly inferior to those of the routine or selective shunting technique, and the rate of restenosis is not higher than that of patch angioplasty closure.

scholarly journals Experience and Technique for Zenker's Diverticulum Per Oral Endoscopic Myotomy: Z-POEM

2020 ◽  
Author(s):  
Eitan Podgaetz ◽  
Vani Konda
Keyword(s):  
Third Space ◽  
Zenker’S Diverticulum ◽  
Complication Rates ◽  
Short Term ◽  
Zenker's Diverticulum ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Invasive Techniques ◽  
Per Oral

Abstract Objective With the advent of minimally invasive surgery, incisionless surgery, and third-space endoscopy, the treatment for Zenker's diverticulum has also moved toward less invasive techniques Methods New incisionless per oral techniques can be applied for cricopharyngeal myotomy in Zenker's diverticulum. Results Five patients underwent Zenker's diverticulum per oral endoscopic myotomy (Z-POEM) without complications, minimal discomfort, and narcotic consumption, with complete resolution of their symptoms by history and Eckardt scores. Conclusions Z-POEM is performed entirely endoscopically with very little associated pain or complication rates, with short-term follow-up having excellent functional and symptomatic results.

scholarly journals Durability of eversion carotid endarterectomy: Comparison with primary closure and carotid patch angioplasty

2001 ◽  
Vol 34 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Tony Katras ◽  
Ulises Baltazar ◽  
Daniel S. Rush ◽  
W.Chris Sutterfield ◽  
Leo M. Harvill ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Primary Closure ◽  
Patch Angioplasty
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