Avtor/Urednik		Miksić, Kazimir; Flis, Vojko; Pavlović, Milan; Tetičkovič, Erih
Naslov		Karotidna endarterektomija - dvajsetletne izkušnje
Prevedeni naslov		Carotid endaretectomy: a twenty-year experience
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 38, št. Suppl 5
Leto izdaje		1999
Obseg		str. 91-6
Jezik		slo
Abstrakt		Background.The study emphasises the importance of accurate preoperative evaluation of patients, the usefulness of transcranial Doppler monitoring, selective shunting and a women Dacron patch angioplasty following carotid endarectomy. Patients, methods and results. Since 1982, more than 700 Dacron patch angioplasties of the carotid artery have been performed at our institution. A restrospective study of 412 carotid reconstructions in 386 patients, performed between July 1982 and January 1990, showed that there were seven deaths during surgery (1.7%) and twelve perioperative strokes (2..9%). Indications for carotid endarterectomy were transient ischemic attacks in 192 cases (46.5%), significant asymptomatic carotid lesion in 123 cases (30%) and a prior major stroke in 97 cases (23.5%). In this series there were no Dacron patch infections or postoperative aneurysms.On the basis of these observations, a prospective study was conducted on 192 patients (mean age 67 years) with 211 carotid endarterectomies performed between January 1990 and January 1997. SUrgery was performed for transient ischemic attacks in 159 cases, stroke in 18 and non-hemispheric symptoms in 34 cases. Perioperative transcranial Doppler monitoring was performed in 91 patients with carotid endarterectomy. Internal shunts were used selectively. Patients underwent duplex scanning one week following surgery and yearly thereafter. Thirty-two patients (15.2%) were lost to follow-up; hence 179 arteries were followed in 173 patients for 12-84 (mean 45.8) months. There was one wound infection and a postoperative aneurysm in the same patient. The incidence of residual stenosis on the one-week scan was 3.9% (7 carotid endartectomies) and that of recurrent stenosis 5% (9 carotid endarterectomies) . Conclusions. Under conditions of appropriate indications and selective use of TCD, a carotid Dacron patch angioplasty after a carotid endarterectomy is associated with very good results.
Izvleček		Študija poudarja pomembnost dobre predoperativne izbire bolnikov, uporabnost transcerebralne Dopplerjeve ultrasonografije, selektivno uporabo internega obvoda ter angioplastiko z dakronsko krpo po opravljeni karotidni endarterektomiji. Bolniki, meetode dela in rezultati.. Od leta 1982 smov naši ustanovi opravili več kot 700 angioplastik arterije karotis z dekronsko krpico. Retrogradno pregledana dokumentacija je zajela 386 bolnikov (412 karotidnih endarterektomij) v obdobju med junijem 1982 in januarjem 1990. V tej skupini je bila oboperativna smrtnost 1,7% (7 bolnikov) ter oboperativna možganska kap 2,9% (12 bolnikov). Indikacije za operacijo so bile pri 192 karotidnih endarterektomijah (30%) asimptomatske pomembne zožitve karotidne arterije ter pri 97 endarterektomijah (23,5%) prebolela možganska kap. V tej skupini ni bilo okužbe dekronske krpice, kakor tudi ne pooperativne anevrizme. Na podlagi teh opazovanj smo izvedli prospektivno študijo, ki je zaje;a 192 bolnikov (povprečna starost 67 let) in 211 endarterektomij med januarjem 1990 in januarjem 1997. 159 bolnikov (75%) je bilo operiranih zaradi predhodnih ishaemičnih napadov, 18 (8,5%) zaradi stanja po možganski kapi ter 34 (16%) zaradi asimptomatskih zožitev arterije karotis. Medoperativno spremljanje možganskega pretoka s transcerebralno Dopplerjevo ultrasonografijo je bilo izvedeno pri 91 endarterektomijah. Notranji obvod smo pri teh bolnikih opravili selektivno. Teden dni in nato letno po operaciji smo opravljali duplex kontrolo. 32 bolnikov (11,5%) smo pri kontrolah izgubili. Tako smo 179 arterij pri 173 bolnikih spremljali 12-84 (povprečno 45,8) mesecev. Imeli smo 2 (0,9%) oboperativni smrti in 4(1,9%) pooperativne kapi. Pri enem bolniku je nastala okužba rane s pooperativno anevrizmo. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		CAROTID STENOSIS ENDARTERECTOMY, CAROTID TREATMENT OUTCOME