Carotid endarterectomy: changing practice patterns.

Abstract

BACKGROUND: Cost-effective carotid endarterectomy implies a good outcome; low morbidity, a short hospital stay and selective use of non-invasive preoperative diagnostic tests done alone. METHODS: A solo surgeon's clinical experience with two hundred and eighteen consecutive operations, over seven years, at two Community Hospitals in Northern Virginia. RESULTS: There were three perioperative strokes, of which one resulted in death, for a mortality rate of 0.45%, and a stroke rate of 1.4%. The majority of the operations in the past two years were done on the basis of Duplex ultrasonography and magnetic resonance angiography, but without invasive angiography. General anesthesia, routine use of shunt and use of autogenous vein patch in almost every case was employed. Patients were selectively observed in the Intensive Care Unit postoperatively. Forty eight percent of the series and 75% of the most recent 121 patients operated on in 1995 and 1996 were discharged on the first postoperative day without any need for re-admission to the hospital. CONCLUSIONS: Carotid endarterectomy can be performed with a short hospital stay and an extremely low morbidity and mortality. Carotid endarterectomy is a highly effective surgical procedure both from the medical and economy stand-points.