Carotid Endarterectomy with Primary Closure: Is It Safe?

Objective: The choice of the optimal closure technique after carotid endarterectomy has long been a matter of debate and primary closure was often considered inferior to patch angioplasty. The purpose of our work was to study the results of carotid endarterectomy with primary closure and to identify the predictive factors of both survival and short- and long-term complications.

Methods: We conducted a retrospective descriptive study including patients operated for atheromatous carotid stenosis by carotid endarterectomy with primary closure. The primary end points were death and immediate and delayed postoperative complications. Clinical and other surgery-related criteria were studied to identify predictive factors for those complications.

Results: One hundred and twenty-eight patients were included. The mean age was 68 years with a sex ratio of 2.6. The mean duration of cross-clamping was 26 minutes. The mean time of the intervention was 72 minutes. Early mortality was 1.6%. The main mortality factor was the intervention time >120 minutes (p = 0.012). In the early postoperative period, three patients (2.3%) presented a homolateral ischemic stroke. Thirteen patients had an acute coronary syndrome (10.2%). Seven patients (5.5%) had a cervical hematoma and seven patients (5.5%) had cranial nerve damage. Only one case of acute carotid thrombosis (0.8%) was observed. Optimization of the mean arterial pressure by more than 20% at clamping was the main factor incriminated in the occurrence of early central neurological complications (p = 0.039). The combined death and stroke rate was 2.3% for symptomatic patients and 1.6 1% for asymptomatic patients. The late restenosis rate was 3.9%, mainly related to compliance with optimal medical therapy (p = 0.034).

Conclusion: Primary closure after carotid endarterectomy is a closure technique equivalent to patch angioplasty. It allows for a reduction in clamping time and thus in the procedure, offers a low rate of mortality and postoperative complications while preventing the specific complications of the vascular patch.

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
10. Juni 2022