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Carotid Endarterectomy: A Practitioner’s 35-Year Experience
Robert I. Hacker, MD, John B. Chang, MD.
Northshore - Long Island Jewish Health System, Manhasset, NY, USA.

Objective: Carotid endarterectomy (CEA) is recognized as the gold standard surgical treatment for symptomatic and asymptomatic carotid lesions. Multiple published manuscripts have described the optimal technical and management details of the procedure, including non-surgical management, optimal drug regiments, best shunting techniques and intra-operative monitoring techniques. Many of the studies published have large numbers of patients, mostly pooled from multiple centers and surgeons. However, few papers report long term follow-up greater than 20-years; fewer report a single surgeon’s outcomes. This study reports a single practitioner’s 35-year experience with CEA.
Methods: Retrospective analysis of prospectively collected data was evaluated from a single vascular surgeon’s database. Inclusion criteria: any patient who underwent a CEA and was closed either primarily or with a greater saphenous vein patch. Results pertaining to side, surgical approach, reoperation rate and reason, 60-day morbidity and mortality and long-term results were analyzed. Data was compared to multiple published reports of CEA both with and without the use of a vein patch.
Results: After 35-years of operating a total of 1029 patients underwent 1173 CEAs, right: 593 (50.55%), left: 580 (49.44%); 144 (13.9%) patients’ underwent bilateral CEA. A total of 953 (81.24%) greater saphenous vein patches were performed with 212 (18.01%) closed primarily, data was unavailable for 8 (.68%) repairs. Restenosis occurred in 16 (1.36%) patients (left-10 right-6, vein patch: 12, primary closure: 4) with an average stenosis of 99% before reoperation. 60-day post operative results for primary closure versus vein patch respectively were: ipsilateral stroke 1.7 % / 0.5 %; mortality 2.2 % / 0.3 % and any stroke related death 3.4% / 0.76%. Over the 35-year analysis a total of 283 patients died of both postoperative and natural causes. Overall the morbidity of CEA with greater saphenous vein patch compared to primary closure was statistically significant, P<0.01.
Conclusion: CEA is a time tested surgical treatment for symptomatic and asymptomatic carotid lesions. Closing the arteriotomy with a saphenous vein patch is safe, effective and stands the test of time. This study reports that a single practitioner’s long-term results are consistent with published record of larger trials. These comparative observations support the notion that CEA closed with a greater saphenous vein patch should be considered the gold standard of surgical treatment for carotid artery disease.


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