Duplex scanning alone before carotid endarterectomy: a 5-year experience.

The role of duplex scanning and arteriography as a means of assessing patients for carotid endarterectomy has been reviewed for the period 1984 to 1988 when 98 carotid endarterectomies were performed. Of these 44 were selected for surgery on the basis of duplex assessment alone, 48 after carotid angiography and duplex scanning and six after angiography alone. No difference between the groups of patients was observed for either perioperative or follow-up complication rates, although all late deaths occurred in patients who had been examined by angiography. By the end of the study period angiography was requested for less than 30% of all patients undergoing carotid endarterectomy. It is argued that the change in our practice is safe provided that certain criteria are met. These include angiography in cases of suspected aortic arch or proximal vessel disease and in those symptomatic patients with a duplex diagnosis of complete occlusion.