Operative Explantation of Inferior Vena Cava Filters

Abstract

Background: Carotid endarterectomy (CEA) has been used since described by Carea in 1956 to treat symptomatic Carotid artery stenosis (CAS) patients with proven efficacy and safety. CEA for asymptomatic patients remains a debate. Objectives: To evaluate the outcome of modified CEA technique in both symptomatic and asymptomatic patients with significant carotid stenosis. Methods: Retrospective study was held at Mercy University Hospital. Two hundreds and eighty patients were admitted between 2005 to 2010 for CEA; 132 patients were asymptomatic and 148 patients were symptomatic. Preoperative patients’ characteristics & indication of surgery were analysed. Operative details were recorded including selective shunting & patching with modified shorter arteriotomy technique. Immediate, early and late post-operative complications, ICU and hospital stay and death rates were assessed. Results: Postoperative transient ischemic attacks (TIA) rate was 2.5% in all patients. Thirty days postoperative strokes were recorded only in symptomatic group (2.14%). Total TIAs and strokes in 30 days postoperative were significantly associated with symptomatic group comparing to asymptomatic one (P 1⁄4 *0.02). ICU and post-operative hospital stay was longer in symptomatic group. All patients postoperative blood transfusion rate was 1.78%. It was statistically associated with symptomatic group (P 1⁄4 *0.04). Other postoperative complications were analysed in both groups with no statistical difference. Mortality rate was (1.4%). It was only registered in symptomatic group. Conclusion: CEA in asymptomatic CAS patient group is safe & effective. It should be done in high volume centres. Modification of endarterectomy technique with selective shunting and patching shorten the surgery time without compromising safety or outcome.