2011, Number 4
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Rev Mex Angiol 2011; 39 (4)
Morbi-mortalidad en endarterectomías carotídeas en el Centro Médico ABC
Toledo VSA, Rojas RGA, Alonso QHT, Pantoja MC
Language: Spanish
References: 27
Page: 153-159
PDF size: 36.83 Kb.
ABSTRACT
Objective: To determine the incidence and type of complications in carotid endarterectomies at the ABC Medical Center: Ten year experience.
Background: Stroke is the fifth cause of death in Mexico. Ischemic stroke is the most common (85%). In our country, the prevalence is 10% in young people and 45% in the elderly population. Costs for care of patients with stroke are elevated, with a significant impact on society. Prevention in susceptible cases for carotid endarterectomy is vital, but can be associated with severe complications in inexperience hands.
Material and methods: We perform an observational, analytical, retrospective longitudinal study at the ABC Medical Center in all patients with diagnosis of carotid artery disease who underwent endarterectomy in the past 10 years (2000-2010).
Results: Seventy one cases met the selection criteria. 22 female (31%) and 49 male (69%). Mean carotid stenosis 77.11% with a standard deviation of 13.67%. Mortality, 0. Morbidity: peripheral neurological 10.6%, bleeding 4.2% and central neurological 2.8%. Primary angioplasty had the highest complication rate 9.8% vs. patch with saphenous vein 5.6% or PTFE 1.4%. There was no significant difference between the type of surgical training (neurosurgery vs. vascular surgery), and the development of complications.
Conclusions: The incidence of carotid endarterectomy complications is within international standards. There were no differences between the type of surgical training in relation to morbi-mortality rates. Primary angioplasty had more complications than patch angioplasty.
REFERENCES
Kolodgie FD. Pathology of atherosclerosis and stenting. Neuroimag Clin N Am 2007; 17: 285-301.
Dirección General de Estadística e Informática de la Secretaría de Salud. Principales resultados de la estadística sobre mortalidad en México, 1997. Sal Púb Méx 1998; 40: 517-23.
Moore. Vascular and endovascular surgery: a comprehensive review. Chap 35. 7th. Ed. 2006.
Cantú-Brito C, et al. Prevalencia de estenosis carotídea en pacientes con isquemia cerebral transitoria en México. Rev Mex Neuroci 2010; 11: 343-8.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273: 1421-8.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high grade-stenosis. N Eng J Med 1991; 325: 445-53.
Rockman C, Loh S. Carotid endarterectomy: Still the standard of care for carotid bifurcation disease. Semin Vasc Surg 2011; 24: 10-20.
Sjrikhande GV, McKinsey JF. Choosing the appropriate intervention for symptomatic and asymptomatic carotid disease in the era of multiple therapies: Integration of risk profile and technical data. Semin Vasc Surg 2011; 24: 53-9.
Rockman CB, Jacobowitz GR, Gagne PJ, et al. Focused screening for occult carotid artery disease: Patients with known heart disease are at high risk. J Vasc Surg 2004; 39: 44-51.
Tovar-Cervantes VM. Experiencia en el tratamiento quirúrgico de la enfermedad carotídea ateroesclerótica en el Hospital Central Militar. Rev Sanid Milit Mex 2007; 61: 18-22.
Gillum RF. Epidemiology of stroke in Hispanic Americans. Stroke 1995; 26: 1707-12.
Sacco RL, Roberts K, Boden-Albala B, Gu Q, Lin I-F, Kargman DE et al. Race-ethnicity and determinants of carotid atherosclerosis in a multiethnic population. The Northern Manhattan stroke study. Stroke 1997; 28: 929-35.
Timaran CH, McKinsey JF, Schneider PA, Littooy F. Reporting standards for carotid interventions from the Society for Vascular Surgery. J Vasc Surg 2011; 53: 1679-95.
Clouse WD, Brewster DC. Cardiopulmonary complications related to vascular surgery. In: Towne JB, Hollier LH (ed.). Complications in Vascular Surgery. 2nd. Ed. New York: Marcel Dekker; 2004: 15-48.
Biller J, Feinberg WM, Castaldo JE, et al. Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1998; 29: 554-62.
Riles TS, Imparato AM, Jacobowitz GR, et al. The cause of perioperative stroke after carotid endarterectomy. J Vasc Surg 1994; 19: 206-16.
GALA Trial Collaborative Group, Lewis SC, Warlow CP, et al. General anesthesia versus local anesthesia for carotid surgery (GALA): a multicenter, randomized controlled trial. Lancet 2008; 372: 2132.
Pomposelli FB, Lamparello PJ, Riles TS, et al. Intracranial hemorrhage after CEA. J Vasc Surg 1988; 7: 248-55.
Nowak LR, Corson JD. Blood pressure instability after carotid endarterectomy. In: Ernst CB, Stanley JD (ed.). Current Therapy in Vascular Surgery. 4th. Ed. St. Louis: Mosby; 2001: 71-3.
Rockman C, Riles TS. Nonstroke complications of carotid endarterectomy. In: Towne JB, Hollier LH (ed.). Complications in Vascular Surgery. 2nd. ed. New York: Marcel Dekker; 2004: 475-82.
Treiman RL, Cossman DV, Foran RF, et al. The influence of neutralizing heparin after carotid endarterectomy on postoperative stroke and wound hematoma. J Vasc Surg 1990; 12: 440-6.
Stone DH, Nolan BW, Schanzer A, et al. Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke. J Vasc Surg 2010; 51: 559.
Blume WT, Ferguson GG, McNeill DK. Significance of EEG changes at carotid endarterectomy. Stroke 1986; 17: 891.
Gough MJ. Optimizing the results of carotid endarterectomy. In: Earnshaw JJ, Murie JA. The Evidence for Vascular Surgery. Castle Hill Barns U.K.; 2007: 15-26.
Halm EA, Hannan EL, Rojas M, et al. Clinical and operative predictors of outcomes of carotid endarterectomy. J Vasc Surg 2005; 42: 420-8.
Bond MBBS, Dphil FRCS. Systematic review of tandomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. J Vasc Surg 2004; 40: 1126-35.
Rockman CB. Primary closure of the carotid artery is associated with poorer outcomes during carotid endarterectomy. J Vasc Surg 2005; 42: 870-7.