Subscribe to RSS
DOI: 10.1055/s-2002-39821
Prevention, Identification, and Management of Perioperative Complications of Carotid Endarterectomy
Publication History
Publication Date:
24 June 2003 (online)
ABSTRACT
Complications from carotid endarterectomy are rare but potentially devastating. The current indications for the operation require a low operative morbidity and mortality. Potential morbidities from carotid endarterectomy include neurological complications (cranial and peripheral nerve injuries, cerebral hyperperfusion syndrome, stroke) and nonneurological complications (neck hematoma/airway obstruction, hypertension, hypotension, cardiac events). Identification of patients at risk for each of these complications allows for preoperative risk reduction and selectively heightened perioperative monitoring. Knowledge of the relevant anatomy and pathophysiology of these complications leads to implementation of appropriate management strategies to minimize their sequelae.
KEYWORDS
Carotid endarterectomy - complications - stroke
REFERENCES
- 1 Beard J D, Mountney J, Wilkinson J M. et al . Prevention of postoperative wound haematomas and hyperperfusion following carotid endarterectomy. Eur J Vasc Endovasc Surg . 2001; 21 490-493
- 2 Munro F J, Makin A P, Reid J. Airway problems after carotid endarterectomy. Br J Anaesth . 1996; 76 156-159
- 3 Wong J H, Findlay J M, Suarez-Almazor M E. Hemodynamic instability after carotid endarterectomy: risk factors and associations with operative complications. Neurosurgery . 1997; 41 35-43
- 4 Eagle K A, Berger P B, Calkins H. et al . ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery: executive summary Circulation . 2002; 105 1257-1267
- 5 Weitz H H. Perioperative cardiac complications. Med Clin North Am . 2001; 85 1151-1169
- 6 Sprung J, Abdelmalak B, Gottlieb A. et al . Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anesthesiology . 2000; 93 129-140
- 7 AbuRahma A F, Lim R Y. Management of vagus nerve injury after carotid endarterectomy. Surgery . 1996; 119 245-247
- 8 Curran A J, Smyth D, Sheehan S J, Joyce W, Bouchier Hayes D, Walsh M A. Recurrent laryngeal nerve dysfunction following carotid endarterectomy. J R Coll Surg Edinb . 1997; 42 168-170
- 9 Forssell C, Kitzing P, Bergqvist D. Cranial nerve injuries after carotid artery surgery: a prospective study of 663 operations. Eur J Vasc Endovac Surg . 1995; 10 445-449
- 10 Keunen R, Nijmeijer H W, Tavy D. et al . An observational study of preoperative transcranial Doppler examinations to predict cerebral hyperperfusion following carotid endarterectomies. Neurol Res . 2001; 23 593-598
- 11 Hosoda K, Kawaguchi T, Shibata Y. et al . Cerebral vasoreactivity and internal carotid artery flow help to identify patients at risk for hyperperfusion after carotid endarterectomy. Stroke . 2001; 32 1567-1573
- 12 Riles T S, Imparato A M, Jacobowitz G R. et al . The cause of perioperative stroke after carotid endarterectomy. J Vasc Surg . 1994; 19 206-216
- 13 Radak D, Popovic A D, Radicevic S R, Neskovic A N, Bojic M. Immediate reoperation for perioperative stroke after 2250 carotid endarterectomies: differences between intraoperative and early postoperative stroke. J Vasc Surg . 1999; 30 245-251
- 14 Findlay J M, Marchak B E. Reoperation for acute hemispheric stroke after carotid endarterectomy: is there any value?. Neurosurgery . 2002; 50 486-493
- 15 Rockman C B, Jacobowitz G R, Lamparello P J. et al . Immediate reexploration for the perioperative neurologic event after carotid endarterectomy: is it worthwhile?. J Vasc Surg . 2000; 32 1062-1070
- 16 Westerband A, Mills J L, Berman S S, Hunter G C. The influence of routine completion arteriography on outcome following carotid endarterectomy. Ann Vasc Surg . 1997; 11 14-19
- 17 AbuRahma A F, Robinson P A, Short Y S. Management options for post-carotid endarterectomy stroke. J Cardiovasc Surg . 1996; 37 331-336
- 18 Anzuini A, Briguori C, Roubin G S. et al . Emergency stenting to treat neurological complications occurring after carotid endarterectomy. J Am Coll Cardiol . 2001; 37 2074-2079
- 19 Perler B A, Murphy K, Sternbach Y, Gailloud P, Shake J G. Immediate postoperative thrombolytic therapy: an aggressive strategy for neurologic salvage when cerebral thromboembolism complicates carotid endarterectomy. J Vasc Surg . 2000; 31 1033-1037