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DOI: 10.1055/s-2001-19646
© Georg Thieme Verlag Stuttgart · New York
Wertigkeit der intraoperativen Duplexsonographie bei der Carotisendarterektomie
Assessment of Intraoperative Duplexsonography During Carotid EndarterectomyPublikationsverlauf
Publikationsdatum:
22. Januar 2002 (online)
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Summary
Introduction: Carotid endarterectomy (CEA) for prevention of strokes mandates a high amount of experience and a meticulous surgical technique. Intraoperative morphologic as well as hemodynamic monitoring of the endarterectomized arteries is rarely performed. The purpose of this study was to determine the value of intraoperative colour-coded-duplex-sonography to recognize eventual intraoperative technical problems that might result in serious cerebral damage.
Methods: Prospective analysis of the medical data of all patients who underwent CEA for treatment of high-grade carotid stenosis between 1996 and 1999. Adequacy of the repair was assessed intraoperatively by duplexsonography.
Results: Of 142 consecutive patients with a median age of 68 (43-84) years, 104 (73 %) were men and 38 (27 %) were women. 9 patients (6 %) had bilateral CEAs. Intraoperative duplexsonography revealed abnormalities during 11 (7 %) of 151 CEAs. 4 (3 %) were considered major and underwent immediate revision. There was one (0.7 %) temporary neurologic deficit (hyperperfusion syndrome) and 2 (1.3 %) cases of fatal intracerebral hemorrhage. 6 (4 %) postoperative surgical complications occurred, i. e. 3 cases of major wound hematoma (with revision) and 3 cases of temporary cranial nerve palsy. Median length of follow-up was 11 (3-35) months. No late neurologic event occurred during follow-up. 5 (3 %) patients developed asymptomatic restenosis.
Discussion: Routine intraoperative duplexsonography is a valuable and reliable diagnostic tool to detect correctable technical problems during CEA that subsequently may lead to neurological deficits, fatal stroke or a high incidence of restenosis.
Zusammenfassung
Einleitung: Die Carotisendarterektomie (CEA) bei hochgradigen oder symptomatischen Carotisstenosen ist gegenwärtig das Verfahren der Wahl zur Vermeidung eines cerebro-vaskulären Insultes (CVI). Zur Optimierung der Operationstechnik ist eine intraoperative Qualitätskontrolle unabdingbar. Ziel der Studie war die Untersuchung der Wertigkeit der intraoperativen Duplexsonographie in der Erkennung von technischen Fehlern und hämodynamischen Flussunregelmäßigkeiten, die unerkannt zu folgenschweren Komplikationen führen können.
Methodik: Prospektive Datenanalyse aller Patienten, die wegen Carotisstenosen zwischen 1996-1999 von 2 verantwortlichen Operateuren operiert worden sind. In allen Fällen wurde eine intraoperative Duplexsonographie als Qualitätskontrolle durchgeführt.
Ergebnisse: Unter 142 konsekutiven Patienten mit einem Durchschnittsalter von 68 (43-84) Jahren fanden sich 104 (73 %) Männer und 38 (27 %) Frauen. Bei 9 (6 %) Patienten wurde eine bilaterale CEA durchgeführt. Die intraoperative Duplexsonographie ergab insgesamt in 11 (7 %) Fällen einen pathologischen Befund, der in 4 (3 %) Fällen zur unverzüglichen Revision führte. Zwei (1,3 %) Patienten verstarben postoperativ als Folge eines hämorrhagischen CVI und ein Patient erlitt ein temporäres neurologisches Ereignis. Die Morbidiät betrug 4 %, entsprechend 3 Nachblutungen und 3 temporären Neuropraxien. Es waren keine neurologischen Spätkomplikationen während einer mittleren Nachkontrolldauer von 11 (3-35) Monaten zu verzeichnen. Fünf (3 %) Patienten entwickelten in der Folge eine asymptomatische Restenose.
Diskussion: Die routinemäßige intraoperative Duplexsonographie nach CEA ist ein zuverlässiges und sicheres diagnostisches Verfahren. Technische Fehler und hämodynamische Flussunregelmäßigkeiten, die unter Umständen Früh- oder Spätkomplikationen verursachen, können rechtzeitig erkannt und behoben werden.
Key words
Duplex sonography - Carotid artery - Endarterectomy - Results
Schlüsselwörter
Duplexsonographie - Carotis - Thrombendarterektomie - Resultate
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