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Carotid redo surgery: both safe and durable
Author(s) -
Harris Richard A.,
Stow Nicholas,
Fisher Charles M.,
Neale Michael L.,
Appleberg Michael
Publication year - 2003
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1046/j.1445-2197.2003.t01-8-.x
Subject(s) - medicine , restenosis , carotid endarterectomy , interquartile range , surgery , stenosis , perioperative , angioplasty , asymptomatic , endarterectomy , retrospective cohort study , stent , carotid arteries
Aim: To examine the outcomes and complications of surgery for recurrent carotid stenosis. Methods: From 1974 to 2000, 1922 carotid endarterectomies were performed in our unit. A retrospective cohort analysis of these records identified 24 patients (1.2%) who underwent surgery for recurrent stenosis. Results: There were 13 men and 11 women in the group. Median follow up was 7.2 years (interquartile range 4.4−12.4 years). The indication for redo surgery was either symptomatic severe (80−99%) or moderate (50−79%) restenosis, or severe asymptomatic (80−99%) restenosis. Repair was performed by patch angioplasty (88%), endarterectomy alone (8%) or interposition grafting (4%). Within the 30 day perioperative period there were no deaths, no strokes (major or minor), or significant cardiac morbidity. One patient (4%) developed a permanent spinal accessory nerve deficit. Another patient (4%) required further re‐intervention for recurrent disease. Conclusions: Very low surgical morbidity and mortality was achieved in our unit by implementing a policy of selective re‐intervention for carotid restenosis. Redo carotid endarterectomy can therefore be recommended as having no greater morbidity than primary carotid endarterectomy. Carotid angioplasty and stenting are not recommended as a routine alternative treatment.