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      Early hemodynamic characteristics of eversion and patch carotid endarterectomies

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          Abstract

          Objective

          Carotid endarterectomy (CEA) is currently the gold standard in the operative management of carotid artery stenosis. While eversion and patch CEAs vary greatly in technique, various studies have determined equivalence with regard to clinical outcomes. However, the hemodynamic differences following each procedure are not known. This study aimed to investigate any early hemodynamic differences between eversion and patch CEAs.

          Methods

          All CEAs performed at our institution from March 2012 to June 2018 were aggregated in a retrospective database by querying the 35301 CPT code from the electronic medical record system. Variables collected included gender, age, laterality of CEA, type of procedure, and pre- and post-operative duplex ultrasound (DUS) date and quantitative findings. Exclusion criteria included any procedure with incomplete data, a post-operative DUS > 90 days following the procedure, CEAs with concomitant bypass(es), isolated external carotid artery (ECA) endarterectomies, and re-do CEAs.

          Results

          One hundred and seventy-one CEAs were performed in 161 unique patients. There were 101 males and 60 females, with an average age of 69.7 (38-96; ± 9.36). 63 CEAs were excluded from analysis: 51 due to incomplete data, eight with a > 90 day post-operative DUS, 2 isolated ECA endarterectomies, 1 CEA with a carotid–subclavian bypass, and 1 re-do CEA secondary to an infected patch. Twenty-seven eversion and 81 patch CEAs were included in analysis. There was no difference in procedure laterality or gender between the two cohorts ( p > 0.05); however, patients who received an eversion CEA were older on average (73.3 vs 67.5; p = 0.002). Pre-operative peak systolic velocities (PSV) of the proximal internal carotid artery (ICA), distal ICA, and distal common artery (CCA) were all similar ( p > 0.05). Post-operative DUS was performed at 17.0 and 12.9 days in the eversion and patch CEA cohorts, respectively ( p = 0.12). Post-operative PSV and change in PSV were similar for all three aforementioned segments ( p > 0.05).

          Conclusion

          Although eversion and patch CEAs vary greatly in technique and post-procedure anatomy, there was no significant difference in post-operative PSV or change in PSV at or around the carotid bifurcation.

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          Author and article information

          Contributors
          jesse.chait@gmail.com
          michael.nicoara@nyulangone.org
          pkibrik@gmail.com
          y.ostroz@gmail.com
          natalie.marks@nyulangone.org
          sareh.rajaee@nyulangone.org
          anil.hingorani@nyulangone.org
          enrico.ascher@nyulangone.org
          Journal
          J Ultrasound
          J Ultrasound
          Journal of Ultrasound
          Springer International Publishing (Cham )
          1971-3495
          1876-7931
          8 May 2019
          December 2019
          : 22
          : 4
          : 433-436
          Affiliations
          GRID grid.137628.9, ISNI 0000 0004 1936 8753, Division of Vascular Surgery, , NYU Langone Hospital—Brooklyn, ; Brooklyn, NY USA
          Author information
          http://orcid.org/0000-0002-4755-2596
          Article
          PMC6838266 PMC6838266 6838266 384
          10.1007/s40477-019-00384-3
          6838266
          31069757
          cfef7892-cef5-420b-89a7-799bde7cab88
          © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019
          History
          : 29 January 2019
          : 2 May 2019
          Categories
          Original Article
          Custom metadata
          © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019

          Ultrasound,Carotid stenosis,Carotid endarterectomy,Vascular surgery,Patch endarterectomy,Eversion endarterectomy,Hemodynamics

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