常规颈动脉内膜切除术中颈外动脉内膜切除术的结果。

The outcome of external carotid endarterectomy during routine carotid endarterectomy.

作者信息

Archie J P

机构信息

Wake Medical Center and Carolina Cardiovascular Surgical Associates, Raleigh, NC 27610, USA.

出版信息

J Vasc Surg. 1998 Oct;28(4):585-90. doi: 10.1016/s0741-5214(98)70080-1.

DOI:10.1016/s0741-5214(98)70080-1

PMID:9786250

Abstract

PURPOSE

This study is an analysis of the outcome of a common method of management of the external carotid artery (ECA) during routine carotid endarterectomy (CEA).

METHODS

Between 1986 and 1997, 1069 primary CEAs were performed with a combination of proximal eversion technique and blind distal endarterectomy on the ECA. Of these, 973 CEAs (91%) had 1 or more postoperative duplex scans that included the ECA. Both preoperative and early postoperative studies were performed on 313 of these CEAs. Intraoperative post-CEA continuous-wave Doppler scans identified low flow or occlusion of the ECA in 37 CEAs (4%). These ECAs were isolated and repaired.

RESULTS

The early post-CEA duplex scan velocities were 143 +/- 81 cm/s (mean +/- 1 standard deviation of the mean). In the first 6 months after the CEAs, 692 ECAs (72%) had <50% stenosis, 175 (18%) had 50% to 74% stenosis, 90 (9%) had > or =75% stenosis, and 9 (1%) were occluded. Of the 37 repaired ECAs, 20 (54%) had <50% stenosis, 10 (27%) had 50% to 74% stenosis, 5 (14%) had > or =75% stenosis, and 2 (5%) were occluded. The cumulative life-table > or =50% stenosis rate was 36% at 1 year, 40% at 3 years, 48% at 5 years, and 81% at 10 years. The cumulative > or =75% stenosis rate was 12% at 1 year, 12% at 3 years, 15% at 5 years, and 37% at 10 years. Preoperative studies showed <50% stenosis in 152 of the 313 ECAs (48%). In the early postoperative period, 102 of these ECAs (66%) had <50% stenosis, 35 (23%) had 50% to 74% stenosis, 13 (9%) had > or =75% stenosis, and 3 (2%) were occluded. Of the 161 ECAs with > or =50% preoperative stenosis, 66 (41%) had <50% stenosis in the first 6 months after CEA, 61 (38%) had 50% to 74% stenosis, 32 (20%) had > or =75% stenosis, and 2 (1%) were occluded.

CONCLUSIONS

Combined proximal eversion technique and blind distal ECA endarterectomy during routine CEA gives poor and unacceptable early and late outcomes. The repair of severely obstructed or occluded ECA identified during surgery after CEA has a similarly poor outcome. The technique and management of the ECA during routine CEA needs further investigation and modification.

摘要

目的

本研究旨在分析在常规颈动脉内膜切除术（CEA）过程中，一种处理颈外动脉（ECA）的常用方法的效果。

方法

1986年至1997年间，采用近端外翻技术与ECA盲端内膜切除术相结合的方法，进行了1069例原发性CEA手术。其中，973例（91%）CEA术后进行了1次或更多次包括ECA的双功超声扫描。对其中313例CEA进行了术前和术后早期检查。术中CEA后连续波多普勒扫描发现37例（4%）ECA血流低或闭塞，对这些ECA进行了分离和修复。

结果

CEA术后早期双功超声扫描的血流速度为143±81cm/s（平均值±平均标准差）。在CEA术后的前6个月，692例（72%）ECA狭窄<50%，175例（18%）狭窄50%至74%，90例（9%）狭窄≥75%，9例（1%）闭塞。在37例修复的ECA中，20例（54%）狭窄<50%，10例（27%）狭窄50%至74%，5例（14%）狭窄≥75%，2例（5%）闭塞。累积生命表≥50%狭窄率在1年时为36%，3年时为40%，5年时为48%，10年时为81%。累积≥75%狭窄率在1年时为12%，3年时为12%，5年时为15%，10年时为37%。术前检查显示，313例ECA中有152例（48%）狭窄<50%。术后早期，这些ECA中有102例（66%）狭窄<50%，35例（23%）狭窄50%至74%，13例（9%）狭窄≥75%，3例（2%）闭塞。在术前狭窄≥50%的161例ECA中，66例（41%）在CEA术后的前6个月狭窄<50%，61例（38%）狭窄50%至74%，32例（20%）狭窄≥75%，2例（1%）闭塞。