J A Celi de la Torre1, D A Skrypnik2, R A Vinogradov3, D Böckler4, S Demirel5. 1. Humanmedizin, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland. 2. Abteilung für Gefäßchirurgie und Endovaskuläre Chirurgie, Kreiskrankenhaus Bergstraße, Heppenheim, Deutschland. 3. Abteilung für vaskuläre Chirurgie, S. V. Ochapovsky regionales Krankenhaus No1, Krasnodar, Russland. 4. Chirurgisches Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Dittmar.Boeckler@med.uni-heidelberg.de. 5. Chirurgisches Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
Abstract
BACKGROUND: Postoperative blood pressure alterations after carotid endarterectomy (CEA) are associated with an increased risk of morbidity and mortality. OBJECTIVE: To outline the influence of the two commonly used surgical reconstruction techniques, conventional CEA with patch plasty (C-CEA) and eversion CEA (E-CEA), as well as the innovative carotid sinus-preserving eversion CEA (SP-E-CEA) technique on postoperative hemodynamics, taking the current scientific knowledge into consideration. METHODS: Assessment of the current clinical and scientific evidence on each operative technique found in the PubMed (NLM) database ranging from 1974 to 2017, excluding case reports. RESULTS: A total of 34 relevant papers as well as 1 meta-analysis, which scientifically dealt with the described topic were identified. The results of the studies and the meta-analysis showed that E‑CEA correlates with an impairment of local baroreceptor functions as well as with an elevated need for vasodilators in the early postoperative phase, whereas C‑CEA and SP-E-CEA seem to have a more favorable effect on the postoperative blood pressure. CONCLUSION: The CEA technique influences the postoperative blood pressure regulation, irrespective of the operative technique used. Accordingly, close blood pressure monitoring is recommended at least during the postoperative hospital stay. Further studies are mandatory to evaluate the importance of SP-E-CEA as an alternative to the classical E‑CEA.
BACKGROUND: Postoperative blood pressure alterations after carotid endarterectomy (CEA) are associated with an increased risk of morbidity and mortality. OBJECTIVE: To outline the influence of the two commonly used surgical reconstruction techniques, conventional CEA with patch plasty (C-CEA) and eversion CEA (E-CEA), as well as the innovative carotid sinus-preserving eversion CEA (SP-E-CEA) technique on postoperative hemodynamics, taking the current scientific knowledge into consideration. METHODS: Assessment of the current clinical and scientific evidence on each operative technique found in the PubMed (NLM) database ranging from 1974 to 2017, excluding case reports. RESULTS: A total of 34 relevant papers as well as 1 meta-analysis, which scientifically dealt with the described topic were identified. The results of the studies and the meta-analysis showed that E‑CEA correlates with an impairment of local baroreceptor functions as well as with an elevated need for vasodilators in the early postoperative phase, whereas C‑CEA and SP-E-CEA seem to have a more favorable effect on the postoperative blood pressure. CONCLUSION: The CEA technique influences the postoperative blood pressure regulation, irrespective of the operative technique used. Accordingly, close blood pressure monitoring is recommended at least during the postoperative hospital stay. Further studies are mandatory to evaluate the importance of SP-E-CEA as an alternative to the classical E‑CEA.
Authors: Serdar Demirel; Laura Macek; Nicolas Attigah; Hans Bruijnen; Maani Hakimi; Thomas Able; Dittmar Böckler Journal: J Vasc Surg Date: 2012-05-01 Impact factor: 4.268
Authors: S A Reza Nouraei; Pippa G Al-Rawi; Dominique Sigaudo-Roussel; Dino A Giussani; Michael E Gaunt Journal: J Vasc Surg Date: 2005-04 Impact factor: 4.268
Authors: E Ballotta; L Renon; G Da Giau; A Toniato; C Baracchini; E Abbruzzese; M Saladini; P Moscardo Journal: Ann Surg Date: 2000-07 Impact factor: 12.969