Tan Tze-Woei, Weyman Albert K, Barkhordarian Siamak, Patterson Robert B
Brown University, Providence, RI, USA.
Ann Vasc Surg. 2011 Jan;25(1):87-93. doi: 10.1016/j.avsg.2010.11.004.
Transaortic endarterectomy is a well-described technique for surgical revascularization of orificial atherosclerotic renovascular disease. Adopting this technique to carotid endarterectomy (CEA), modified eversion carotid endarterectomy (MECE), uses a traditional longitudinal arteriotomy that is confined to the bulb. This obviates the need for patch closure, simplifies the procedure, and permits easy conversion to traditional patch closure carotid endarterectomy (PCEA) for technical defects. We compared the safety and efficacy of this technique with PCEA.
Three vascular surgeons performed 223 CEAs between July 2004 and December 2008 at a tertiary teaching hospital. Outcomes measured included perioperative stroke rate, morbidity rate, mortality rate, and late restenosis. The incidence of moderate (60-79%) and severe (≥80%) restenosis was examined at <6 weeks, 1 year, and ≥2 years after operation. All patients included in this study underwent follow-up for >12 months. Data were analyzed with Student's t-test (p < 0.05 = significant).
CEA was performed for symptomatic disease in 40.4% (90/223) of patients. One surgeon performed MECE in 73.3% (99/135) of his patients during this period; the remaining patients (n = 124) underwent traditional PCEA. Intraoperative completion duplex ultrasound was performed for all patients. In 5.1% (5/99) of the patients, MECE was converted to PCEA for residual flaps. Intraoperative carotid cross-clamping time was significantly shorter in the MECE group (29.2 minutes vs. 52.2 minutes, p < 0.05). For patients in the PCEA group, the overall mortality rate was 1.8% (4/223), and perioperative stroke rate was 1.4% (3/223). Overall morbidity was 7.2%, which was similar between the two groups. Late restenosis rate on duplex scan was 7.1% (1.0% severe stenosis), early occlusion occurred in one patient with PCEA, and the reintervention rate was 1.0% (2/196). The incidence of late restenosis was similar between the MECE and PCEA group (8.4% vs. 6.2%, p = 0.55). Mean follow-up was 26.3 months for the MECE group and 29.4 months for the PCEA group.
MECE is a safer alternative to conventional endarterectomy with a restenosis rate comparable with PCEA, offers the potential advantage of shorter clamping time, and obviates the need for patch closure.
经主动脉内膜切除术是一种用于治疗开口处动脉粥样硬化性肾血管疾病手术血运重建的成熟技术。将该技术应用于颈动脉内膜切除术（CEA），改良外翻颈动脉内膜切除术（MECE）采用局限于颈动脉球部的传统纵向动脉切开术。这避免了使用补片缝合的需要，简化了手术过程，并且在出现技术缺陷时可轻松转换为传统补片缝合颈动脉内膜切除术（PCEA）。我们比较了该技术与PCEA的安全性和有效性。
2004年7月至2008年12月期间，三位血管外科医生在一家三级教学医院进行了223例CEA手术。测量的结果包括围手术期卒中率、发病率、死亡率和晚期再狭窄。在术后<6周、1年和≥2年时检查中度（60 - 79%）和重度（≥80%）再狭窄的发生率。本研究纳入的所有患者均接受了超过12个月的随访。数据采用学生t检验进行分析（p < 0.05为有统计学意义）。
40.4%（90/223）的患者因有症状的疾病接受了CEA手术。在此期间，一位外科医生对其73.3%（99/135）的患者进行了MECE手术；其余患者（n = 124）接受了传统PCEA手术。所有患者均进行了术中完成的双功超声检查。5.1%（5/99）的患者因残留皮瓣将MECE转换为PCEA。MECE组术中颈动脉夹闭时间明显更短（29.2分钟对52.2分钟，p < 0.05）。PCEA组患者的总死亡率为1.8%（4/223），围手术期卒中率为1.4%（3/223）。总体发病率为7.2%，两组相似。双功超声扫描的晚期再狭窄率为7.1%（重度狭窄为1.0%），PCEA组有一名患者发生早期闭塞，再次干预率为1.0%（2/196）。MECE组和PCEA组晚期再狭窄的发生率相似（8.4%对6.2%，p = 0.55）。MECE组的平均随访时间为26.3个月，PCEA组为29.4个月。
MECE是传统内膜切除术的一种更安全的替代方法，其再狭窄率与PCEA相当，具有夹闭时间较短的潜在优势，并且无需补片缝合。
