Late follow-up of carotid endarterectomy with venous patch angioplasty

Article Abstract:

The purpose of carotid endarterectomy is to remove the cholesterol-plaque thickened inner lining of either or both carotid arteries, which are the main arteries supplying blood to the brain. This procedure is performed to eliminate transient ischemic attacks (decreased blood flow to the brain); its use in patients without symptoms is controversial. It has been suggested that vein patch angioplasty (vascular reconstruction) be performed in conjunction with carotid endarterectomy to reduce the risk of restenosis (recurrence of narrowing) and arterial occlusion (blockage). A study was undertaken of 83 patients who underwent 90 carotid endarterectomies with venous patch angioplasty to determine the incidence of restenosis. The average patient age at the time of surgery was 64.4 years. The procedures were performed between July 1980 and December 1985. The main reason (in 60 percent of cases) for vein patch angioplasty was small caliber of the internal carotid artery. Following the procedure, arteriography was performed, and all except one endarterectomy was patent. Intermediate follow-up (average 21 months after surgery) was carried out using digital subtraction angiogram; late follow-up (average 55.4 months) was carried out by this procedure or carotid duplex scanning. During the follow-up period 21 patients (representing 23 endarterectomies) died; one death was due to a cerebral event (stroke). Five patients were lost to follow-up and seven moved or refused to continue in the study. During intermediate follow-up, there were three restenoses (4 percent, or 3 of 69 procedures) and five occlusions. By late-follow-up three additional patients developed restenosis; thus, a total of six restenoses occurred in 56 procedures (11 percent). Only 3 of the 11 patients who had recurrence of disease developed symptoms. These findings indicate that venous patching did not routinely prevent recurrence of stenosis, either in the intermediate or late follow-up periods. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Transluminal angioplasty, Balloon angioplasty

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Community hospital carotid endarterectomy in patients over age 75

Article Abstract:

The most common vascular procedure besides heart surgery performed in the US is carotid endarterectomy. Carotid endarterectomy removes the cholesterol-plaque thickened inner lining of the carotid arteries (arteries that provide the main blood supply to the brain). It is questionable whether the benefits of this surgery outweigh the risks and complications, particularly among the elderly who are at greater risk for carotid blockage. A review was undertaken to examine the outcome of patients undergoing carotid endarterectomy surgery at a community hospital. In addition, the incidence of death and stroke in patients over 75 years of age was compared with that of younger patients. There were 810 operations performed on 634 patients; 21 percent of the operations were performed on patients over 75 years (133 patients). The most common reason for the surgery was transient ischemic attack (temporary diminished blood flow to the brain). The older patients were more likely than the younger group to have had a previous heart attack and to require medication to control hypertension. There was also a larger proportion of women in the older group. The incidence of stroke among the older patients was 2 percent compared with a 1 percent incidence among younger patients. The death rate was 5 percent in the older group, and 2 percent in the younger group. Logistic regression showed that when other factors (such as diabetes, pre-existing heart disease, and gender) were controlled, patients over 75 were not at greater risk for stroke or surgery-related mortality than the younger patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Demographic aspects

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Endarterectomy as the procedure of choice for atherosclerotic occlusive lesions of the common femoral artery

Article Abstract:

Isolated blockages (atherosclerosis) of the common femoral artery (the main artery of the upper leg), while rare, are more frequently associated with disabling symptoms due to a lack of blood supply than are similar blockages of the superficial femoral artery (which runs nearer the skin). Resultant pain and limping (claudication) affects the thigh and calf, usually limiting walking distance to one block. Out of 29 patients undergoing removal of the blockage and inner layers (endarterectomy) of the common femoral artery, 17 suffered from disabling limping, six suffered from pain when at rest, and six suffered from ulcers of the affected limb caused by the lack of blood supply. Endarterectomy was confined to the common femoral artery in ten patients but was carried into either or both the deep (deep within the leg) and superficial femoral arteries in nineteen patients. All patients were discharged from the hospital with reconstructed arteries free of blockage. Amputations were avoided in the twelve patients with advanced ischemic symptoms (lack of blood supply) in parts of the leg. Ninety-four percent of these patients had no blockage in the common femoral artery five years after surgery.

Arteriosclerosis, Intermittent claudication, Angioplasty, Femoral artery

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