Relationship between intraoperative color-flow duplex findings and early restenosis after carotid endarterectomy: A preliminary report

• Published in: Journal of vascular surgery Vol. 24; no. 4; pp. 588 - 596
• Main Authors: Papanicolaou, George, Toms, Carla, Yellin, Albert E., Weaver, Fred A.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.10.1996
• Subjects: Adult; Aged; Aged, 80 and over; Arteriosclerosis - diagnostic imaging; Arteriosclerosis - surgery; Blood Flow Velocity; Carotid Arteries - diagnostic imaging; Carotid Arteries - physiopathology; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Endarterectomy, Carotid; Female; Humans; Intraoperative Complications - diagnostic imaging; Intraoperative Period; Male; Middle Aged; Prospective Studies; Recurrence; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(96)70074-5

Purpose: This study was undertaken to examine the relationship between intraoperative color-flow duplex (CFD) findings and the development of restenosis in patients undergoing carotid endarterectomy (CEA). Methods: Seventy-eight patients (43 male and 35 female; mean age, 65 years) underwent 86 CEAs (eight staged bilateral) and intraoperative CFD during a 31-month period. Three patients (three CEAs, 3%) underwent both CFD and a completion arteriographic scan. Patients were observed in a postoperative protocol using CFD surveillance. The follow-up interval ranged from 6 to 24 months (average, 12 months). Results: After undergoing CEA, 10 patients (10 CEAs, 11%) had an abnormality detected by intraoperative CFD; one was confirmed with a completion arteriographic scan. These abnormalities consisted of elevated peak systolic velocities (PSV) with a mosaic color pattern suggesting turbulence seen in six CEAs, including one internal carotid artery (ICA) with abnormal hemodynamics and an unremarkable completion arteriogram. Intimal defects on B-mode were seen in another four CEAs. These carotid arteries were reexplored, defects (intimal flaps with platelet thrombus) were confirmed by direct examination, and all were repaired with or without a patch (six ICAs, three external carotid arteries, and one common carotid artery). No cerebrovascular events occurred in the perioperative period. No carotid restenosis (≥50% diameter reduction) was identified during follow-up of 43 patients (48 CEAs, 56%). Two patients had recurrent neurologic symptoms. Conclusion: Intraoperative CFD is an effective test for detecting flow abnormalities or intimal defects in patients undergoing CEA. Ensuring normal intraoperative hemodynamics after CEA may be a major factor associated with decreased incidence of perioperative cerebrovascular events and subsequent carotid artery restenosis. (J Vasc Surg 1996;24:588-96.)