Troëng T, Bergqvist D, Norrving B, Ahari A
Department of Surgery, Blekinge Hospital, Karlskrona, Sweden.
Eur J Vasc Endovasc Surg. 1999 Jul;18(1):59-64. doi: 10.1053/ejvs.1999.0858.
to study possible relations between indications, contraindications and surgical technique and stroke and/or death within 30 days of carotid endarterectomy (CEA).
analysis of hospital records for patients identified in a national vascular registry.
during 1995-1996, 1518 patients were reported to the Swedish Vascular Registry - Swedvasc. Among these the sixty-five with a stroke and/or death within 30 days were selected for study. Complete surgical records were reviewed by three approved reviewers using predetermined criteria for indications and possible errors.
an error of surgical technique or postoperative management was found in eleven patients (17%). In six cases (9%) the indication was inappropriate or there was an obvious contraindication. The indication was questionable in fourteen (21.5%). Half of the patients (52.5%) had surgery for an appropriate indication, and no contraindication or error in surgical technique or management was identified.
more than half the complications of CEA represent the "method cost", i.e. the indication, risk and surgical technique were correct. However, the stroke and/or death rate might be reduced if all operations conformed to agreed criteria.
研究颈动脉内膜切除术（CEA）的适应症、禁忌症、手术技术与术后30天内发生中风和/或死亡之间的可能关系。
对国家血管登记处中确定的患者的医院记录进行分析。
1995年至1996年期间，1518例患者被报告纳入瑞典血管登记处——瑞典血管登记系统（Swedvasc）。其中，选取了30天内发生中风和/或死亡的65例患者进行研究。由三名经批准的审核人员根据预定的适应症标准和可能存在的错误对完整的手术记录进行审核。
11例患者（17%）存在手术技术或术后管理错误。6例患者（9%）的适应症不恰当或存在明显禁忌症。14例患者（21.5%）的适应症存在疑问。一半的患者（52.5%）接受手术的适应症恰当，且未发现手术技术或管理方面的禁忌症或错误。
CEA超过一半的并发症代表了“方法成本”，即适应症、风险和手术技术是正确的。然而，如果所有手术都符合商定的标准，中风和/或死亡率可能会降低。
