RESUMEN
OBJECTIVE: To determine the criteria for choosing a surgical approach and compare an effectiveness of carotid endarterectomy (CEAE) via 3 approaches. MATERIAL AND METHODS: The study included 120 patients who underwent CEAE via 3 different approaches. Intraoperative skin marking included lower jaw angle, skin fold closest to common carotid artery bifurcation. Carotid artery bifurcation and borders of atherosclerotic plaque were visualized using ultrasound. An effectiveness of each access was evaluated in accordance with the following criteria: neurological complications, cosmetic effect and quality of life after 1 and 12 months. The patients were divided into 2 groups. Group I - 80 patients with CEAE with access through the natural skin fold (NSF); group II - 40 patients with CEAE using the classical longitudinal access. The 1st group was divided into 2 subgroups. Subgroup I A - 39 patients with CEAE using mini-access via NSF; subgroup I B - 41 patients with CEAE using extended access via NSF. RESULTS: There were no strokes and transient ischemic attacks in a month after surgery in both groups. After 12 months, stroke occurred in 2 (%) patients of group II, cranial neuropathy - 8 (21%) patients in the same group. The best cosmic effect was achieved in subgroup I A after 1 and 12 months (37.1±6.7 scores). Mean score of physical health was 51.59±5.9 scores in subgroup I A, 46.03±7.53 scores - in subgroup I B, 38.84±5.28 scores - in group II. Index of mental health was 49.63±6.69, 45.68±5.6, and 48.59±7.29 scores, respectively. CONCLUSION: Considering these data, we developed a personalized computer program ensuring fast choice of optimal surgical approach.
Asunto(s)
Estenosis Carotídea , Endarterectomía Carotidea , Accidente Cerebrovascular , Arterias Carótidas , Arteria Carótida Común , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Humanos , Calidad de Vida , Resultado del TratamientoRESUMEN
AIM: The study was aimed at comparing the results of eversion carotid endarterectomy and carotid endarterectomy with patch plasty in the immediate and remote postoperative periods. MATERIALS AND METHODS: The literature was retrieved by means of electronic databases, with the dates of publications ranging from 1970 to 2019. According to the inclusion and exclusion criteria we selected the literature making it possible to carry out a meta-analysis in the immediate and remote postoperative periods. The results were obtained with the help of the Stata 14 software package. Eventually, we retrieved and analysed a total of 2139 articles. Of these, ten were included into the study and contained 3568 patients subjected to 3672 operations (eversion carotid endarterectomy - 1718 and carotid endarterectomy with a patch - 1954). The results of the meta-analysis were as follows: the mean time of carotid artery cross-clamping for eversion carotid endarterectomy was shorter than that for carotid endarterectomy with a patch (4.1±2.9 min); the frequency of using intraoperative temporary bypass in eversion carotid endarterectomy turned out to be significantly less compared with carotid endarterectomy with patch plasty - 13.5% (91/672) and 62.0% (492/793), OR=0.183, 95% CI: 0.136-0.254, p<0.001; the incidence rate of ischaemic stroke in the immediate and remote postoperative periods was significantly lower after eversion carotid endarterectomy than that after carotid endarterectomy with patch plasty - OR=0.452, 95% CI: 0258-0.792, p=0.005 and OR=0.300, 95% CI; 0.155-0.579, p=0.000. The development of restenosis in the immediate and remote postoperative periods was observed less often for eversion carotid endarterectomy compared with carotid endarterectomy with patch plasty - OR=0.604, 95% CI: 0.422-0.864, p=0.006. CONCLUSION: Eversion carotid endarterectomy was associated with shorter time of carotid artery cross-clamping, lower frequency of intraoperative temporary bypass, lower number of cases of ischaemic stroke in the immediate and remote postoperative periods, as well as those of restenosis in the long-term postoperative period.
Asunto(s)
Isquemia Encefálica , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Accidente Cerebrovascular/etiología , Arterias Carótidas , Humanos , Recurrencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To identify the advantages and disadvantages of different approaches for carotid endarterectomy (conventional, longitudinal and transverse incision). MATERIAL AND METHODS: There were 58 patients who underwent carotid endarterectomy. Patients were divided into 2 groups depending on surgical approach. Group 1 (n=37) - minimal skin incision (less than 5 cm). There were subgroup 1A (transverse minimal skin incision along the natural skin wrinkle, n=17) and subgroup 1B (longitudinal minimal skin incision, n=20). Group 2 (n=21) - conventional longitudinal incision. Surgical outcomes were analyzed after 1 month and 1 year. End-points were mortality, stroke, TIA, cranial nerve neuropathy. Cosmetic effect was evaluated using POSAS scale (Patient and Observer Scar Assessment Scale, Draaijers, 2004). RESULTS: Mortality, stroke and TIA were absent after 1 month. Cranial nerve neuropathy was not observed in subgroup 1A and diagnosed in 2 (10%) patients of subgroup 1B and 6 (28.5%) patients of group 2. Cosmetic effect: subgroup 1A - 48.4±9.5 scores, subgroup 1B - 52.4±9.2, group 2 - 63.1±11.1 (p<0.05). The outcomes after 12 months: mortality was absent in subgroups 1A and 1B, 2 patients died in group 2 from AMI. Stroke was absent in subgroups 1A and 1B, group 2 - 1 patient. Cranial nerve neuropathy was absent in 1A and 1B subgroups and diagnosed in 4 (21%) patients of group 2. Cosmetic effect: subgroup 1A - 37.2 scores, subgroup 1B - 40.0 scores, group 2 - 55.1 scores. Physical component of QOL: subgroup 1A - 51.63±6.31 scores, subgroup 1B - 46.01±7.53 scores, group 2 - 38.85±5.33 scores. Psychological component of QOL: subgroup 1A - 49.64±6.72 scores, subgroup 1B - 45.68±5.63 scores, group 2 - 48.6±7.36 scores (p<0.05). CONCLUSION: Transverse minimal skin incision for carotid endarterectomy is a safe alternative to classic longitudinal incision and reduces the risk of postoperative complications with significant cosmetic effect.
Asunto(s)
Estenosis Carotídea/cirugía , Procedimientos Quirúrgicos Dermatologicos/métodos , Endarterectomía Carotidea/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Herida Quirúrgica , Estenosis Carotídea/complicaciones , Estenosis Carotídea/mortalidad , Técnicas Cosméticas , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/mortalidad , Resultado del TratamientoRESUMEN
Occlusion of the superficial femoral artery is a frequently encountered pathology in peripheral vascular disease. In patients with chronic lower limb ischaemia in a lesion of crural arteries the results of femoropopliteal bypass grafting are unsatisfactory, therefore, the deep femoral artery becomes the decisive collateral pathway for perfusion of the lower extremity. PATIENTS AND METHODS: The study included a total of 166 patients presenting with TASC II B, C and D type lesions of the femoropopliteal segment after profundoplasty, who were subdivided into 3 groups depending on the stage of chronic lower limb ischaemia: Group 1 - 95 patients with stage II B, Group 2 - 56 patients with stage III, and Group 3 - 15 patients with stage IV. RESULTS: Five years after profundoplasty in Group 1 amputation was avoided in 90 patients (94.7%) in Group 2 - in 47 patients (83.9%), where p=0.028. During 14 months in Group 3 due to unsatisfactory distal bed 15 patients (100%) were subjected to amputation of the operated lower limb at various levels. The binary logistic regression analysis of the diameter of the deep femoral artery (p=0.045, OR=0.139) and the state of the distal arterial bed (p=0.02, OR=9.341) demonstrated that the diameter of the artery directly influenced the outcome of profundoplasty within up to 5 years. CONCLUSION: Profundoplasty is an effective operation from the point of view of clinical and haemodynamic outcomes for patients presenting with occlusion of the superficial femoral artery and stenosis of the deep femoral artery with stage IIB and III chronic lower limb ischaemia. The diameter of the deep femoral artery and the condition of the arterial bed are the factors influencing the results of profundoplasty within up to 5 years.