Speciality
Spotlight

 




 


Neurology


 

 






Carotid Artery Surgery – CEA

   

  • DL Dawson, CA Rosebury , RM Fujitani


    Preoperative Testing Before Carotid Endarterectomy : A Survey of Vascular Surgeons’ Attitudes



    Ann Vasc Surg 11: 264-272, 1997


      


    Published guidelines from vascular societies call for contrast arteriography as a routine before carotid endarterectomy [CEA]. However, in numerous studies, authors have foregone this invasive test if [I] clinical indications for CEA are clear and [2] results of technically adequate duplex scan are suggestive. The authors asked vascular surgeons about their preferences and practices regarding contrast arteriography and noninvasive duplex scanning as preoperative evaluations for CEA.

     


    The authors mailed surveys to 502 active members of the Peripheral Vascular Society. The response from 430 [86%] was analyzed. For some comparisons the respondents were stratified by their surgical experience [300 CEAS and less or 300 CEAS and more], time in practice [ 10 years and less and 10 years and more].

     


    Preoperative duplex scanning was used more often than arteriograms [93% vs 82%] and duplex scanning was considered the most important diagnostic study [25% vs 20%]. Other preoperative assessments included MRI of the brain [14%], CT of the brain [12%], and MR angiography [10%]. A majority of the respondents [283 or 71%] reported that they had performed CEA without arteriography at least once. In fact when appropriate indications for surgery are present, one third of the respondents [33%] believed that CEA without arteriography was appropriate at least half the times. All told, 73% of respondents believed that if appropriate indications for surgery are present, CEA can be performed without preoperative arteriography. Attitudes towards CEA were similar for respondents with differing surgical experience, time in practice and type of practice.

     


    The acceptance of CEA with carotid duplex scanning but without preoperative arteriography seems to be high and widespread. Nonetheless 82% of respondents will use preoperative
    arteriograms. 

     

  • BA
    Perler, A Dardik, GP Burleyson, et al


    Influence of Age and Hospital Volume on the Results of Carotid Endarterectomy – CEA : A Statewide Analysis of 9918 CASES.



    J Vasc Surg 27: 25-33, 1998


         


    The number of elderly candidates for carotid endarterectomy [CEA] may increase markedly in the future. The effects of patient age and other variables on CEA outcomes were examined. 

        


    Data were obtained from the Maryland Health Services Review Commission database. 9918 patients undergoing elective CEA in all acute care hospitals in the state between 1990 and 1995 were identified. The post operative death and neurological complication rates were 0.9% and 1.7% respectively; these rates were higher with age increases in patients; being 0.8% and 1.7% for age below 65 years; 0.9% and 1.8% for patients between 65 and 69 years; 0.9% and 1.8% for those 70 to 79 years and 1.4 and 1.3 in those aged 80 years or more. Mean length of stay in hospital and charges increased in a linear fashion with age from 4.2 days at $6550 for those below 65 years to 5.6 days at $ 7756 for those 80 years and older. The mortality rates were 1.9% in low volume hospitals; 1.1 in moderate volume hospitals and 0.8% in high volume hospitals. The corresponding neurological complication rates were 6.1%, 1.3% and 1.8% respectively.

        


    In most hospitals CEA is a safe procedure even among the very elderly. Older patients may require longer hospital stay corresponding with greater medical complexity.

        

Carotid
Endarterectomy [CEA] and Need for

Intensive Care Unit [ ICU ]

  

  • Rigdon
    EE, Monajjem N, Rhodes RS

    Criteria for Selective Utilization of the Intensive
    Care Unit Following Carotid Endarterectomy


    Ann
    Vasc Surg 11: 20-27, 1997


           

    Patients
    undergoing CEA are routinely admitted to the ICU for
    fear of adverse postoperative events.
    Some authors have questioned this practice and
    have proposed criteria for selective admission of high
    risk patients only. Adverse
    outcomes after CEA and associated risk factors were
    identified in a review to develop restrictive criteria
    for postoperative ICU admission.

       

    The
    review included 365 CEAs performed over a 15-year
    period. Records
    were analyzed to identify adverse events in the first
    24 hours after surgery, that could have been prevented
    if managed in the ICU.
    Adverse events included strokes, cardiac
    events, reoperation for bleeding, and the need for
    intensive pulmonary care.
    Preoperative variables that could potentially
    predict such events were also analyzed. The effects of
    ICU admission on patient outcomes were then assessed.

       

    A
    total of 46 events in 38 patients developed in the
    first 24 hours after CEA that could be best managed in
    the ICU. The adverse factors associated with an
    increased risk of such events occurring, included
    emergency CEA, cardiac disease in the preceding 6
    months, and anti-coagulation therapy.
    Based on indications, 69% of patients would
    have been admitted to standard units, 16% in units
    with ECG monitoring, and 15% in ICU.
    Of the large number [69%] admitted to standard
    units, 1.6% developed adverse events and all of these
    could be managed units only without ICU transfer.

        

    The
    authors conclude that of all patients undergoing CEA,
    only those who have emergency CEA, or require
    postoperative anticoagulation therapy, or who have
    intraoperative strokes or major cardiac 
    complications, or chronic renal failure, should
    be admitted to ICUs. Patients
    with prior recent cardiac problems can be nursed in
    standard units with ECG. All the rest can be safely nursed in standard units.

        

 



 

 

Speciality Spotlight

 

 
Neurology
 

 

Carotid Artery Surgery – CEA
   

  • DL Dawson, CA Rosebury , RM Fujitani
    Preoperative Testing Before Carotid Endarterectomy : A Survey of Vascular Surgeons’ Attitudes
    Ann Vasc Surg 11: 264-272, 1997
      
    Published guidelines from vascular societies call for contrast arteriography as a routine before carotid endarterectomy [CEA]. However, in numerous studies, authors have foregone this invasive test if [I] clinical indications for CEA are clear and [2] results of technically adequate duplex scan are suggestive. The authors asked vascular surgeons about their preferences and practices regarding contrast arteriography and noninvasive duplex scanning as preoperative evaluations for CEA.
     
    The authors mailed surveys to 502 active members of the Peripheral Vascular Society. The response from 430 [86%] was analyzed. For some comparisons the respondents were stratified by their surgical experience [300 CEAS and less or 300 CEAS and more], time in practice [ 10 years and less and 10 years and more].
     
    Preoperative duplex scanning was used more often than arteriograms [93% vs 82%] and duplex scanning was considered the most important diagnostic study [25% vs 20%]. Other preoperative assessments included MRI of the brain [14%], CT of the brain [12%], and MR angiography [10%]. A majority of the respondents [283 or 71%] reported that they had performed CEA without arteriography at least once. In fact when appropriate indications for surgery are present, one third of the respondents [33%] believed that CEA without arteriography was appropriate at least half the times. All told, 73% of respondents believed that if appropriate indications for surgery are present, CEA can be performed without preoperative arteriography. Attitudes towards CEA were similar for respondents with differing surgical experience, time in practice and type of practice.
     
    The acceptance of CEA with carotid duplex scanning but without preoperative arteriography seems to be high and widespread. Nonetheless 82% of respondents will use preoperative arteriograms. 
     

  • BA Perler, A Dardik, GP Burleyson, et al
    Influence of Age and Hospital Volume on the Results of Carotid Endarterectomy – CEA : A Statewide Analysis of 9918 CASES.
    J Vasc Surg 27: 25-33, 1998
         
    The number of elderly candidates for carotid endarterectomy [CEA] may increase markedly in the future. The effects of patient age and other variables on CEA outcomes were examined. 
        
    Data were obtained from the Maryland Health Services Review Commission database. 9918 patients undergoing elective CEA in all acute care hospitals in the state between 1990 and 1995 were identified. The post operative death and neurological complication rates were 0.9% and 1.7% respectively; these rates were higher with age increases in patients; being 0.8% and 1.7% for age below 65 years; 0.9% and 1.8% for patients between 65 and 69 years; 0.9% and 1.8% for those 70 to 79 years and 1.4 and 1.3 in those aged 80 years or more. Mean length of stay in hospital and charges increased in a linear fashion with age from 4.2 days at $6550 for those below 65 years to 5.6 days at $ 7756 for those 80 years and older. The mortality rates were 1.9% in low volume hospitals; 1.1 in moderate volume hospitals and 0.8% in high volume hospitals. The corresponding neurological complication rates were 6.1%, 1.3% and 1.8% respectively.
        
    In most hospitals CEA is a safe procedure even among the very elderly. Older patients may require longer hospital stay corresponding with greater medical complexity.
        

Carotid Endarterectomy [CEA] and Need for
Intensive Care Unit [ ICU ]
  

  • Rigdon EE, Monajjem N, Rhodes RS
    Criteria for Selective Utilization of the Intensive Care Unit Following Carotid Endarterectomy
    Ann Vasc Surg 11: 20-27, 1997
           
    Patients undergoing CEA are routinely admitted to the ICU for fear of adverse postoperative events. Some authors have questioned this practice and have proposed criteria for selective admission of high risk patients only. Adverse outcomes after CEA and associated risk factors were identified in a review to develop restrictive criteria for postoperative ICU admission.
       
    The review included 365 CEAs performed over a 15-year period. Records were analyzed to identify adverse events in the first 24 hours after surgery, that could have been prevented if managed in the ICU. Adverse events included strokes, cardiac events, reoperation for bleeding, and the need for intensive pulmonary care. Preoperative variables that could potentially predict such events were also analyzed. The effects of ICU admission on patient outcomes were then assessed.
       
    A total of 46 events in 38 patients developed in the first 24 hours after CEA that could be best managed in the ICU. The adverse factors associated with an increased risk of such events occurring, included emergency CEA, cardiac disease in the preceding 6 months, and anti-coagulation therapy. Based on indications, 69% of patients would have been admitted to standard units, 16% in units with ECG monitoring, and 15% in ICU. Of the large number [69%] admitted to standard units, 1.6% developed adverse events and all of these could be managed units only without ICU transfer.
        
    The authors conclude that of all patients undergoing CEA, only those who have emergency CEA, or require postoperative anticoagulation therapy, or who have intraoperative strokes or major cardiac  complications, or chronic renal failure, should be admitted to ICUs. Patients with prior recent cardiac problems can be nursed in standard units with ECG. All the rest can be safely nursed in standard units.
        

 

 

By |2022-07-20T16:44:18+00:00July 20, 2022|Uncategorized|Comments Off on Carotid Artery Surgery – CEA

About the Author: