IngentaConnect Duplex imaging immediately prior to carotid endarterectomy

Authors: Laurence, J.M.¹; McCarthy, M.J.¹; London, N.J.M.¹; Bell, P.R.F.¹; Naylor, A.R.¹

Source: Annals of The Royal College of Surgeons of England, Volume 87, Number 6, November 2005 , pp. 443-444(2)

Publisher: The Royal College of Surgeons of England

Abstract:

Introduction: In this centre, angiography is used only in selected cases, whilst duplex ultrasound (DU) is the main imaging method prior to carotid endarterectomy (CEA). DU has no associated morbidity and so can be repeated immediately before surgery to detect changes in the carotid plaque or degree of stenosis.

Patients and Methods: We retrospectively examined our Vascular Surgery Audit database for the last 500 patients admitted for CEA. In each case, the DU scan was repeated immediately before surgery.

Results: From 500 admissions, repeat DU immediately prior to surgery detected 8 (1.6%) situations where CEA would no longer have been an appropriate intervention. In four cases, the degree of stenosis was found to be less than 70% on the repeat scan - in three cases the internal carotid artery (ICA) had occluded or sub-occluded and in one case there was a dissection of the ICA plaque.

Conclusions: DU can be repeated, with no associated morbidity, immediately prior to surgery. Such a practice changes management decisions in 1.6% of admissions for CEA, allowing surgery unjustified by current evidence to be avoided. This policy also serves several other important purposes: it is a method of internal validation, provides a means of improving training of vascular technologists and of achieving quality assurance in DU techniques.

Keywords: DUPLEX ULTRASOUND; CAROTID ENDARTERECTOMY

Document Type: Research article

DOI: 10.1308/003588405X60588

Affiliations: 1: Department of Surgery, Leicester General Hospital, Leicester, UK