Re‐evaluation of criteria for reoperation in carotid endarterectomy using intraoperative duplex imaging

Background: The aim of this study was to compare data obtained during surgery with data collected at 6 weeks after operation to evaluate appropriate criteria for reoperation. Methods: One hundred and twenty consecutive patients undergoing carotid endarterectomy had duplex scans at operation and 6 weeks later. Neurological evaluation was also documented. Results: Of 96 patients who had a normal intraoperative duplex scan by standard criteria, 91 had normal scans at 6 weeks. One occluded an internal carotid artery (ICA) at 6 weeks with no symptoms. Four had kinks or high‐grade contralateral lesions leading to velocity enhancement but no filling defect. All were asymptomatic. Twenty‐four patients had abnormal intraoperative scans. Thirteen patients had visible kinking of the ICA or reperfusion hyperaemia; 12 of these patients had normal 6‐week scans and one had a mild residual kink but no symptoms. Eleven patients had visible colour‐filling defects and significant velocity enhancement. Nine of these were reopened and refashioned. Subsequent duplex imaging was satisfactory in all cases and 6‐week scans were normal. One patient had an occluded ICA at operation and developed a dense stroke after operation. Another had residual raised velocities distally which remained at 6 weeks. This patient had no symptoms. Conclusion: Intraoperative velocity measurements alone cannot be relied upon as an indication for reoperation. Significant velocity enhancement combined with a visible filling defect appears to represent a satisfactory criterion for reoperation. There were no complications as a result of reoperation. There was no early restenosis in the whole group and there were no neurological sequelae in any patient with a satisfactory scan using the above criteria. © 1999 British Journal of Surgery Society Ltd