Fiorani P, Sbarigia E, Speziale F, Abi Rached H
Università degli Studi La Sapienza, I Cattedra di Chirurgia Vascolare.
Ann Ital Chir. 1997 Jul-Aug;68(4):483-8.
After fourty years of practice in carotid surgery the rate of neurologic complications related to technical defects seems not to be reduced and still is responsible of 30-40% of all perioperative strokes. Intraoperative quality control seem at present, of outmost importance to further reduce the impact of technical defects on perioperative neurological complications. Angiography, Duplex Scanning and more recently angioscopy have been utilized as intraoperative assessments. All of them demonstrated imperfections of arterial reconstruction potentially at risk for early and late patency failure and indicated immediate intraoperative correction. In some report this behaviour determined a relevant reduction both on perioperative results and lesser incidence of early restenosis. Concerning postoperative control of carotid endarterectomy early restenosis represent the most important and more common failure after carotid endarterectomy. In spite of the efforts to clear the causes of this phenomenon, none of the numerous papers published in literature has defined a specific cause determining restenosis. Nevertheless, at present, this hyperplastic response of the arterial wall to trauma after operation is generally considered benign because rarely is responsible for new neurological symptoms or early internal carotid artery occlusion. This unanimous conviction has been achieved after years of instrumental and clinical postoperative follow-up performed all over the world. At the same time and probably for the above mentioned reasons, recently, has begun a new discussion about the usefulness and cost-effectiveness of prolonged Duplex scanning postoperative surveillance of the endarterectomized carotid arteries. After a meticolous review of our experience as the review of many reports of literature we, in agreement with others, are convinced that the patients operated of carotid endarterectomy, need, in most cases, a short even aggressive period of careful follow up (generally the first six months). If during this period no irregularities or new stenosis is detected at the site of the endarterectomy, we believe that it is justified the patients to be withdrawn from a prolonged instrumental follow-up, permitting laboratory working time to be redirected towards the diagnosis of new vascular diseases.
在颈动脉手术实践四十年后，与技术缺陷相关的神经并发症发生率似乎并未降低，仍占所有围手术期中风的30 - 40%。目前，术中质量控制对于进一步降低技术缺陷对围手术期神经并发症的影响至关重要。血管造影、双功超声扫描以及最近的血管内镜检查已被用作术中评估手段。所有这些检查都显示出动脉重建存在缺陷，可能面临早期和晚期通畅失败的风险，并提示需要立即进行术中纠正。在一些报告中，这种做法使围手术期结果得到了显著改善，早期再狭窄的发生率也有所降低。关于颈动脉内膜切除术的术后监测，早期再狭窄是颈动脉内膜切除术后最重要且最常见的失败情况。尽管人们努力探究这一现象的原因，但文献中众多论文均未明确确定再狭窄的具体原因。然而，目前普遍认为，术后动脉壁对创伤的这种增生性反应是良性的，因为它很少导致新的神经症状或早期颈内动脉闭塞。这一一致的观点是在全球范围内多年的仪器检查和临床术后随访后得出的。同时，可能由于上述原因，最近开始了一场关于延长双功超声扫描对接受内膜切除术的颈动脉进行术后监测的实用性和成本效益的新讨论。在对我们的经验以及许多文献报告进行细致回顾后，我们与其他人一致认为，大多数接受颈动脉内膜切除术的患者在术后需要一段短暂甚至积极的密切随访期（通常是前六个月）。如果在此期间在内膜切除部位未发现异常或新的狭窄，我们认为让患者停止长期的仪器随访是合理的，这样可以将实验室工作时间重新导向对新血管疾病的诊断。
