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PVSS1. Eversion Carotid Endarterectomy: A Versatile And Durable Procedure. An Analysis Of 7,781 Procedures

R. Clement Darling III, Sean P. Roddy, Manish Mehta, Philip S. K. Paty, Benjamin B. Chang, Paul B. Kreienberg, Kathleen J. Ozsvath, Yaron Sternbach, Dhiraj M. Shah.
Albany Medical College, Albany, N.Y.

OBJECTIVES: Eversion carotid endarterectomy (CEA) is an effective form of management for atherosclerotic carotid bifurcation disease. Despite the early origins of this technique, it is still used infrequently as an alternative to the standard longitudinal patch closure. In this study we outline our results with the use of eversion endarterectomy for carotid disease over the past 14 years in over 7,700 cases.

METHODS: From August 1993 to November 2006, all patients undergoing CEA were reviewed retrospectively in our vascular registry. Patients undergoing combined CEA with coronary procedures were included. The preferred anesthetic technique for CEA was regional with shunt on demand except in combined procedures where general anesthesia was used without shunt. Mortality and morbidity were reviewed and demographics analyzed. Restenosis was defined at >70%.

RESULTS: 6,638 patients underwent 7,781 CEAs in the study period using the eversion technique. There were 667 procedures performed with combined coronary procedures. The majority (91%) were done in awake patients with a regional anesthesia. Shunts were used on demand in 1.2% of patients undergoing awake CEA. The operative mortality was 51/7114 (0.7%) in the solely eversion group and 21/667 (3.2%) in those patients undergoing combined procedures. There were 76 permanent and 65 temporary neurologic deficits in the eversion group. In long term follow-up there were 102 recurrent stenoses in the eversion group. There was no difference in stroke or mortality based on gender or on the presence/absence of diabetes.

CONCLUSIONS: Eversion endarterectomy can be performed safely with low stroke mortality rates. It can be used in high risk patients with acceptable results and has minimal restenosis in long term follow-up.