Drain placement confers no benefit after carotid endarterectomy in the Vascular Quality Initiative

Whereas bleeding complications requiring a return to the operating room (OR) after carotid endarterectomy (CEA) are infrequent (1%), they are associated with an increased 30-day combined postoperative stroke or death rate. Drain placement after CEA varies among vascular surgeons, and there are limited data to support the practice. The goal of this study was to evaluate factors leading to drain placement and the effect of drains on postoperative outcomes including return to OR for bleeding, stroke, and death.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research

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Introduction: Controversy persists regarding the use of Protamine during carotid endarterectomy (CEA) despite real world evidence to support its use. The purpose of this study was to best determine the impact of protamine reversal of heparin anticoagulation on the outcome of CEA throughout the United States.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Abstract BACKGROUND: The aim of this study was to evaluate the frequency of postoperative complications in patients who underwent coronary artery bypass grafting (CABG) and simultaneous carotid endarterectomy (CEA) and find predictors of postoperative complications. METHODS: We retrospectively evaluated 86 patients after simultaneous CABG and CEA. Inclusion criteria were: patients with asymptomatic carotid stenosis with a reduction of the carotid lumen diameter of more than 70% detected with Doppler ultrasound and diagnosed with one, two, or three vessel coronary artery disease with coronary stenosis more tha...
Source: The Heart Surgery Forum - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Heart Surg Forum Source Type: research
ConclusionWe thought that CEA remains the most efficient treatment modality among symptomatic and asymptomatic octogenarians with severe carotid artery stenosis and no difference was found compared to non-octogenarians. Advanced age should not be considered as a  high-risk group and selected octogenarians are good candidates for CEA.
Source: European Surgery - Category: Surgery Source Type: research
In conclusion, this review provides an overview of the pathophysiological mechanism of stroke following carotid revascularization (both CAS and CEA) and of the technical improvements that have contributed to reducing this stroke risk. PMID: 30827087 [PubMed - as supplied by publisher]
Source: The Journal of Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: J Cardiovasc Surg (Torino) Source Type: research
Authors: Inanc Y, Mete A, Giray S, Inanc Y Abstract INTRODUCTION: Despite the use of embolic protective devices in the majority of cases applied with carotid stenting to prevent embolic neurological complications related to the carotid stenting procedure, this procedure is applied to some cases without protection. The aim of this study was to present the clinical outcomes of carotid artery stent application without a cerebral embolism protective device. MATERIAL AND METHOD: A retrospective examination was made of a total of 171 patients applied with a stent between 2014 and 2017. The patients included in the st...
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
This study aims to evaluate the impact of simple direct pressure postoperatively on the development of haematoma. Materials and methods From 2011 to 2016, 161 consecutive CEA were performed by a single surgeon or trainee under supervision. After 80 operations, the postoperative technique was altered, with additional pressure being applied by the surgeon to the skin incision from completion of suturing until each patient was awake in the recovery room. The rates of postoperative haematoma and other complications were compared between the pre- and post-intervention groups, as well as grade of surgeon, urgency of operation an...
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
Authors: De┼čer SB, Demirag MK, Kolbakir F Abstract INTRODUCTION: The carotid endarterectomy is already well established in patients with symptomatic or asymptomatic internal carotid artery (ICA) stenosis. The aim of this study was to determine whether there is a difference in postoperative blood pressure changes, stroke rate and postoperative complications following eversion carotid endarterectomy (E-CEA) and conventional carotid endarterectomy (C-CEA). METHODS: From 1 January 2010 to 31 March 2017 consecutive patients admitted to our department with symptomatic or asymptomatic ICA stenosis were included in th...
Source: Acta Chirurgica Belgica - Category: Surgery Tags: Acta Chir Belg Source Type: research
We report herein the successful perioperative management of a 57-year-old man with a type I Glanzmann thrombasthenia undergoing coronary artery bypass graft surgery and right carotid endarterectomy. The patient suffered from several lesions in the three major coronary arteries and in the right carotid necessitating surgery. Prophylactic human leukocyte antigen (HLA)-matched platelets transfusions were continuous administrated before, and through the immediate perioperative period. Posttransfusion platelet recovery was monitored using flow cytometry to determine the percentage of circulating platelet expressing CD61 (β...
Source: Blood Coagulation and Fibrinolysis - Category: Hematology Tags: Case Report Source Type: research
Background: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking.Summary: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe...
Source: Cerebrovascular Diseases - Category: Neurology Source Type: research
Two recent meta-analyses investigated the risks and benefits of heparin reversal by protamine after carotid endarterectomy (CEA).1,2 They found that heparin reversal with protamine reduces the risk for reoperation due to bleeding without an increased risk of stroke, myocardial infarction, or death. Yet, we would like to address the hemostatic and hemodynamic effects of protamine.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Letter to the Editor Source Type: research
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