Jamil Muhammad, Usman Rashid, Ghaffar Salma
Department of Vascular Surgery, Combined Military Hospital, Lahore, Pakistan.
Department of Vascular Surgery, Combined Military Hospital, Lahore Cantt, Pakistan.
Ann Vasc Dis. 2016;9(4):285-288. doi: 10.3400/avd.oa.16-00036. Epub 2016 Sep 21.
To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year. Shunt was used only in 5% (n = 6) patients. Of these, 2.5% (n = 3) patients were those who developed neurological symptoms on clamping the internal carotid and deployment of shunt resulted in complete resolution of symptoms. 2.5% (n = 3) had severe bilateral carotid stenosis and shunt was deployed. One of these patients developed stroke which was permanent. There was no mortality. The mean procedure time was 170 min in patients in whom shunt was used, when compared with 100 min in patients without shunt (P = 0.003). Use of shunt in carotid endarterectomy under local anesthesia as selective policy has an advantage in terms of cost effectiveness, operation time and prevention of potential complications.
评估在局部麻醉下行颈动脉内膜切除术（CEA）时选择性使用分流管的优势。共纳入122例符合国际指南的连续患者。仅在双侧严重颈动脉闭塞性疾病患者或颈动脉夹闭时出现神经症状的患者中选择性使用分流管。随访1个月每周进行1次；然后3个月每月进行1次；然后1年每3个月进行1次。仅5%（n = 6）的患者使用了分流管。其中，2.5%（n = 3）的患者在夹闭颈内动脉时出现神经症状，使用分流管后症状完全缓解。2.5%（n = 3）有严重双侧颈动脉狭窄并使用了分流管。这些患者中有1例发生了永久性卒中。无死亡病例。使用分流管的患者平均手术时间为170分钟，未使用分流管的患者为100分钟（P = 0.003）。在局部麻醉下行颈动脉内膜切除术时选择性使用分流管在成本效益、手术时间和预防潜在并发症方面具有优势。
