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Safety and durability of concomitant carotid endarterectomy with carotid-subclavian bypass grafting
- Source :
- Journal of Vascular Surgery. 73:968-974
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Concomitant carotid endarterectomy (CEA; for severe internal carotid artery stenosis) with carotid-subclavian bypass grafting (CSBG; for proximal common carotid artery or subclavian artery occlusion) is rarely used. Only a few studies have been reported. This report analyzed early and late clinical outcomes of the largest study to date of the combined procedures in our institution. Methods Electronic medical records of patients who had concomitant CEA with CSBG during three decades were analyzed. Indications for surgery were arm ischemia, neurologic events, and clinical subclavian steal. Early (30 days) perioperative complications (stroke, death, and others) and late complications (stroke, death) were recorded. Kaplan-Meier analysis was used to estimate late graft/CEA primary patency, freedom from stroke, and stroke-free survival rates. Graft patency was determined clinically and confirmed using duplex ultrasound. Outcomes were compared with previously published data on isolated CSBG by the same group. Results There were 37 combined procedures analyzed. Mean age was 64 years (range, 45-81 years). Indications for surgery were arm ischemia in 12 (32%), hemispheric transient ischemic attack or stroke in 15 (41%), vertebrobasilar insufficiency in 4 (11%), symptomatic subclavian steal in 10 (27%), and asymptomatic common carotid artery occlusion with severe internal carotid artery stenosis in 6 (16%). The 30-day perioperative (stroke and death) rate was 5.4% (one stroke and one death). Immediate symptom relief was noted in 100%, with 2.7% (transient ischemic attack) symptom recurrence. The crude patency rate of both CEA and CSBG was 92%. At 1 year, 2 years, 3 years, 4 years, and 5 years, respectively, primary patency rates were 100%, 96%, 96%, 96%, and 85%; freedom from stroke rates were 97%, 97%, 97%, 97%, and 97%; and stroke-free survival rates were 94%, 94%, 87%, 82%, and 78%. When these outcomes were compared with the isolated CSBG group alone (28 patients), there was no difference in perioperative stroke (2.7% for concomitant CEA/CSBG vs 0% for isolated CSBG), perioperative death (2.7% vs 2.8%), or late patency rates (92% vs 96%). Conclusions Concomitant CEA/CSBG is safe and durable. There was no significant difference in perioperative stroke/death or late patency rates compared with isolated CSBG.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Subclavian Artery
Carotid endarterectomy
030204 cardiovascular system & hematology
Risk Assessment
Severity of Illness Index
Asymptomatic
03 medical and health sciences
Subclavian Steal Syndrome
0302 clinical medicine
Risk Factors
medicine.artery
Occlusion
medicine
Electronic Health Records
Humans
Carotid Stenosis
cardiovascular diseases
030212 general & internal medicine
Common carotid artery
Vertebrobasilar insufficiency
Vascular Patency
Subclavian artery
Aged
Retrospective Studies
Aged, 80 and over
Endarterectomy, Carotid
business.industry
Perioperative
Middle Aged
medicine.disease
Surgery
Stroke
Treatment Outcome
Ischemic Attack, Transient
Regional Blood Flow
Concomitant
Female
Vascular Grafting
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Carotid Artery, Internal
Subjects
Details
- ISSN :
- 07415214
- Volume :
- 73
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....f981f1caca844b7bc510913cdc109c25