The extracranial carotid vascular bed surgery



Year of publication 2009
Type Article in Proceedings
Conference XXXIV Angiological Days 2009
MU Faculty or unit

Faculty of Medicine

Field Cardiovascular diseases incl. cardiosurgery
Keywords Carotid artery; diagnostic; anestesiology; carotid endarterectomy
Description Surgical treatment of stenoses of extracranial arteries in the carotid vascular bed is connected with certain risks. An efficient prevention is following the rule of reservation of the patients care exclusively for the specialized workplaces with experienced staff which can guarantee correct indication for surgery, treatment, and postoperative care. At our department all the patients examination data are assessed and surgery indication decisions are made by a special commission whose member is also a neurologist. Between January 1990 and June 2008, 1185 extracranial carotid vascular bed operations were performed at the 2nd Department of Surgery of St. Anne's University Hospital Brno. The use of a shunt during the operation depends on the patients condition during the surgery. The current trend is that all the patients without any proven contraindication to regional anaesthesia are primarilly indicated for operation without the use of a shunt. During the surgery, toleration of temporary closure of the carotid artery is tested. In case of intolerance, the regional anaesthesia is changed to general one and a shunt is inserted. There were 936 surgical interventions without the shunt (79%) and 249 interventions with the shunt (21%) performed. Endarterectomy of the carotid artery (common carotid artery and internal carotid artery) with a venous patch was performed 735 times (62%). Endarterectomy of the carotid artery (common carotid artery and internal carotid artery) with an artificial patch (PTFE and polyurethane) was perfmormed 225 times (19%). Other types of surgery (e.g. eversion endarterectomy, plication according to Sottiurai, resection with reanastomosis, replacement with a graft from the great saphenous vein) were performed 225 times (19% of patients). In 59 patients (5%), restenosis in the carotid vascular bed occurred after extracranial carotid vascular bed surgery. 109 patients (9,2%) were affected by postoperative nerve paresis; in 61 patients (5,1%) there was temporary paresis, in 48 patients (4,1%) permanent paresis. 21 patients (1,8%) were affected by stroke and 12 patients (1%) died.
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