Speciality
Spotlight

   




   

Surgery


   

 





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.

  • Mangano CM, for the Multicenter Study of Perioperative Ischemia Research Group [Stanford Univ, Calif; Ischemia Research and Education Found, San Fransisco; Emory Univ, Atlanta, Ga; et al]

    Renal Dysfunction After Myocardial Revascularization : Risk Factors, Outcomes, and Hospital Resource Utilization

    Ann Intern Med 128: 194-203, 1998



    The effects of cardiac surgery on renal function remain unclear. Renal function abnormalities can result from nonpulsatile flow, increased catecholamine and inflammatory mediator levels, renal embolic insults, and release of free hemoglobin from traumatized erythrocytes. Renal dysfunction was studied in a large population of patients undergoing cardiopulmonary bypass and myocardial revascularization.



    A total of 2,222 patients undergoing myocardial revascularization at 24 research hospitals were studied. Their rates of postoperative renal failure [defined as need for dialysis] and of renal dysfunction [defined as a postoperative serum creatinine level of 2.0 mg/dL or greater and an increase in serum creatinine of 0.7 mg/dL or greater from the preoperative level ] were assessed. 



    By these definitions, postoperative dysfunction occurred in 7.7% of patients and renal failure in 1.4%. Mortality was 0.9% patients with neither adverse renal outcome, compared with 19% for those with renal dysfunction and 63% for those with renal failure. The risk of renal failure increased steadily with age: doubled for patients in their 70s and tripled for those in their 80s, compared with younger patients, Factors associated with renal dysfunction, were type 1 diabetes mellitus, preoperative glucose level, congestive heart failure, previous coronary artery bypass grafting, and postoperative creatinine level of 2.0 mg/dL. More than 80% of patients with renal dysfunction had intraoperative or postoperative hemodynamic instability or hemorrhage. 



    An 8% rate of renal dysfunction or failure was documented in patients undergoing myocardial revascularization. Renal risk is related to patient -specific factors, probably reflecting diffuse atherosclerosis. The findings have implications for preoperative communication of risk, treatment with potential nephrotoxic drugs, and surgical technique.


           



 

   

Speciality Spotlight

   

   
Surgery
   

 

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.

  • Mangano CM, for the Multicenter Study of Perioperative Ischemia Research Group [Stanford Univ, Calif; Ischemia Research and Education Found, San Fransisco; Emory Univ, Atlanta, Ga; et al]
    Renal Dysfunction After Myocardial Revascularization : Risk Factors, Outcomes, and Hospital Resource Utilization
    Ann Intern Med 128: 194-203, 1998

    The effects of cardiac surgery on renal function remain unclear. Renal function abnormalities can result from nonpulsatile flow, increased catecholamine and inflammatory mediator levels, renal embolic insults, and release of free hemoglobin from traumatized erythrocytes. Renal dysfunction was studied in a large population of patients undergoing cardiopulmonary bypass and myocardial revascularization.

    A total of 2,222 patients undergoing myocardial revascularization at 24 research hospitals were studied. Their rates of postoperative renal failure [defined as need for dialysis] and of renal dysfunction [defined as a postoperative serum creatinine level of 2.0 mg/dL or greater and an increase in serum creatinine of 0.7 mg/dL or greater from the preoperative level ] were assessed. 

    By these definitions, postoperative dysfunction occurred in 7.7% of patients and renal failure in 1.4%. Mortality was 0.9% patients with neither adverse renal outcome, compared with 19% for those with renal dysfunction and 63% for those with renal failure. The risk of renal failure increased steadily with age: doubled for patients in their 70s and tripled for those in their 80s, compared with younger patients, Factors associated with renal dysfunction, were type 1 diabetes mellitus, preoperative glucose level, congestive heart failure, previous coronary artery bypass grafting, and postoperative creatinine level of 2.0 mg/dL. More than 80% of patients with renal dysfunction had intraoperative or postoperative hemodynamic instability or hemorrhage. 

    An 8% rate of renal dysfunction or failure was documented in patients undergoing myocardial revascularization. Renal risk is related to patient -specific factors, probably reflecting diffuse atherosclerosis. The findings have implications for preoperative communication of risk, treatment with potential nephrotoxic drugs, and surgical technique.

           

 

By |2022-07-20T16:41:32+00:00July 20, 2022|Uncategorized|Comments Off on Carotid Artery Surgery – CEA

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