Kharroubi A, Petit-Colau M D, Jouhannet C, Mameli A, Karsenti A, Gigou F, Tremblay B
Department of vascular and thoracic surgery, GHEF (Grand Hôpital de l'Est Francilien), Meaux site, 6-8 St fiacre street, BP 218, 77104 Meaux Cedex, France; Ibn Zohr University, Faculty of Medicine and Pharmacy, department of Vascular surgery, quartier Tilila, 80000 Agadir, Morocco.
Department of vascular and thoracic surgery, GHEF (Grand Hôpital de l'Est Francilien), Meaux site, 6-8 St fiacre street, BP 218, 77104 Meaux Cedex, France.
J Med Vasc. 2020 Sep;45(5):260-267. doi: 10.1016/j.jdmv.2020.07.005. Epub 2020 Aug 13.
Carotid endarterectomy has traditionally been the strategy for the surgical management of carotid stenosis. Alongside the usual techniques, this study presents another technique: endarterectomy with systematized resection-anastomosis.
A retrospective study from January 2006 to December 2018, included all patients managed for carotid stenosis at Meaux hospital with the "endarterectomy with systematized resection-anastomosis" technique. The perioperative death and stroke rate were evaluated according to the judgment criterion "homolateral ischemic stroke and any stroke or perioperative death". Statistical analysis of the data was performed using SPSS software.
For 415 carotids operated, we identified 240 managed with this technique. The average age was 71.7±9.6 years, 70% men and 30% women. The main cardiovascular risk factor was hypertension (76.7%), 24.2% of patients had an ischemic heart disease history, 43.7% homolateral ischemic stroke and 29% transient ischemic attack. Bilateral lesions were diagnosed in 6.2% of patients and 7.5% had contralateral occlusion. Carotid stenosis was symptomatic in 52.9% of patients. The average stenosis rate observed was 82.9±8.1% on computed tomography angiogram and 83.7±7.7% on magnetic resonance angiogram. The shunt was used in 45.4% of procedures. The average length of stay was 5.9±2.3 days. All patients had satisfactory results in terms of patency and anatomical appearance on the 1st check. In the post-operative period during the first month, complications occurred in 12.5% of patients (1.6% acute coronary syndrome, 0.8% neurological event, 0.8% death, 0.4% infection, 12.1% hematoma, 1.6% recovery for bleeding). The overall perioperative death and stroke rate was 2.6%. Myocardial infarction and sepsis were the causes of death for the 2 patients in the peri operative period. The mean duration of follow-up was 21.2 months, without any restenosis or occurrence of neurological complications. One patient died beyond the 1st month of follow-up without established cause, and the overall mortality rate was 1.3%.
Thromboendarterectomy with "systematized" anastomosis resection represents an angioplasty method for carotid stenosis surgical management under visual control.
传统上，颈动脉内膜切除术一直是治疗颈动脉狭窄的手术策略。除了常用技术外，本研究还介绍了另一种技术：系统化切除-吻合术的内膜切除术。
一项回顾性研究，时间跨度为2006年1月至2018年12月，纳入了所有在莫医院采用“系统化切除-吻合术的内膜切除术”技术治疗颈动脉狭窄的患者。根据“同侧缺血性卒中及任何卒中或围手术期死亡”的判断标准评估围手术期死亡率和卒中发生率。使用SPSS软件对数据进行统计分析。
在415例接受手术的颈动脉中，我们确定有240例采用了该技术。平均年龄为71.7±9.6岁，男性占70%，女性占30%。主要心血管危险因素为高血压（76.7%），24.2%的患者有缺血性心脏病史，43.7%有同侧缺血性卒中，29%有短暂性脑缺血发作。6.2%的患者诊断为双侧病变，7.5%有对侧闭塞。52.9%的患者颈动脉狭窄有症状。在计算机断层血管造影上观察到的平均狭窄率为82.9±8.1%，在磁共振血管造影上为83.7±7.7%。45.4%的手术使用了分流器。平均住院时间为5.9±2.3天。所有患者在首次检查时通畅情况和解剖外观方面均取得满意结果。在术后第一个月内，12.5%的患者出现并发症（1.6%急性冠状动脉综合征，0.8%神经系统事件，0.8%死亡，0.4%感染，12.1%血肿，1.6%因出血而恢复）。围手术期总体死亡率和卒中发生率为2.6%。心肌梗死和脓毒症是围手术期2例患者的死亡原因。平均随访时间为21.2个月，无任何再狭窄或神经系统并发症发生。1例患者在随访第1个月后死亡，死因不明，总体死亡率为1.3%。
采用“系统化”吻合切除术的血栓内膜切除术是一种在视觉控制下治疗颈动脉狭窄的血管成形术方法。
Zotero 插件