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Revitalizing traditional carotid endarterectomy methods: A comprehensive review of primary closure techniques

Year 2025, Volume: 18 Issue: 3, 6 - 6
https://doi.org/10.31362/patd.1565193

Abstract

Purpose: Carotid endarterectomy (CEA) remains essential for the treatment of carotid artery disease; however, primary closure techniques have recently gained interest. This study investigated the outcomes, efficacy, and safety of primary closure compared with conventional methods.
Methods: A retrospective analysis of 130 patients who underwent CEA with primary closure at our clinic between January 2018 and April 2024 was performed. All surgeries followed a standardized procedure under general anesthesia. Data on demographics, surgical time, cross-clamp time, mortality, morbidity, and length of hospital stay were collected. Follow-up evaluations were performed 1, 6, and 12 months post-surgery.
Results: The study included 130 patients, 90 males (69%) and 40 females (31%), with an average age of 69.54±5.42 years. Restenosis occurred in five patients (3%) at 12 months, all of whom were asymptomatic. Three patients experienced transient ischemic attacks (TIA) postoperatively, which fully resolved within one month. Importantly, no early mortality was recorded during the one-month follow-up period.
Conclusion: Primary closure in CEA demonstrates promising outcomes, with low rates of restenosis and postoperative complications and no early mortality. These findings highlight primary closure as a potentially advantageous approach for CEA. Further research and prospective trials are necessary to validate and optimize this technique and ultimately improve patient outcomes in carotid artery disease management.

References

  • Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis [published correction appears in N Engl J Med. 2010 Jul 29;363(5):498] [published correction appears in N Engl J Med. 2010 Jul 8;363(2):198]. N Engl J Med. 2010;363(1):11-23. doi:10.1056/NEJMoa0912321
  • Grotta JC. Clinical practice. Carotid stenosis. N Engl J Med. 2013;369(12):1143-1150. doi:10.1056/NEJMcp1214999
  • Howell SJ. Carotid endarterectomy. Br J Anaesth. 2007;99(1):119-131. doi:10.1093/bja/aem137
  • Byrne J, Feustel P, Darling RC 3rd. Primary closure, routine patching, and eversion endarterectomy: what is the current state of the literature supporting use of these techniques?. Semin Vasc Surg. 2007;20(4):226-235. doi:10.1053/j.semvascsurg.2007.10.006
  • Cheng I, Vyas KS, Velaga S, Davenport DL, Saha SP. Outcomes of Carotid Endarterectomy with Primary Closure. Int J Angiol. 2017;26(2):83-88. doi:10.1055/s-0037-1601053
  • Naylor AR, Sayers RD, McCarthy MJ, et al. Closing the loop: a 21-year audit of strategies for preventing stroke and death following carotid endarterectomy. Eur J Vasc Endovasc Surg. 2013;46(2):161-170. doi:10.1016/j.ejvs.2013.05.005
  • Rerkasem A, Orrapin S, Howard DP, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2020;9(9):CD001081. Published 2020 Sep 12. doi:10.1002/14651858.CD001081.pub4
  • North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445-453. doi:10.1056/NEJM199108153250701
  • Hobson RW 2nd, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med. 1993;328(4):221-227. doi:10.1056/NEJM199301283280401
  • Norton LW, Spencer FC. Long-term comparison of vein patch with direct suture. Technique of anastomosis of small arteries. Arch Surg. 1964;89:1083-1088. doi:10.1001/archsurg.1964.01320060151027
  • Rockman CB, Halm EA, Wang JJ, et al. Primary closure of the carotid artery is associated with poorer outcomes during carotid endarterectomy. J Vasc Surg. 2005;42(5):870-877. doi:10.1016/j.jvs.2005.07.043
  • Kapoor R, Evins AI, Marcus J, Rigante L, Kubota M, Stieg PE. Selective Patch Angioplasty and Intraoperative Shunting in Carotid Endarterectomy: A Single-Center Review of 141 Procedures. Cureus. 2015;7(10):e367. Published 2015 Oct 28. doi:10.7759/cureus.367
  • Hertzer NR, Beven EG, O'Hara PJ, Krajewski LP. A prospective study of vein patch angioplasty during carotid endarterectomy. Three-year results for 801 patients and 917 operations. Ann Surg. 1987;206(5):628-635. doi:10.1097/00000658-198711000-00013
  • White CJ. Carotid artery stenting. J Am Coll Cardiol. 2014;64(7):722-731. doi:10.1016/j.jacc.2014.04.069
  • International Carotid Stenting Study investigators, Ederle J, Dobson J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial [published correction appears in Lancet. 2010 Jul 10;376(9735):90. Nasser, H-C [corrected to Nahser, H-C]]. Lancet. 2010;375(9719):985-997. doi:10.1016/S0140-6736(10)60239-5
  • Bonati LH, Dobson J, Featherstone RL, et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015;385(9967):529-538. doi:10.1016/S0140-6736(14)61184-3
  • Sternbergh WC 3rd, Crenshaw GD, Bazan HA, Smith TA. Carotid endarterectomy is more cost-effective than carotid artery stenting. J Vasc Surg. 2012;55(6):1623-1628. doi:10.1016/j.jvs.2011.12.045
  • Kilaru S, Korn P, Kasirajan K, et al. Is carotid angioplasty and stenting more cost effective than carotid endarterectomy?. J Vasc Surg. 2003;37(2):331-339. doi:10.1067/mva.2003.124
  • Zagzoog N, Elgheriani A, Attar A, et al. Comprehensive comparison of carotid endarterectomy primary closure and patch angioplasty: A single-institution experience. Surg Neurol Int. 2022;13:1. Published 2022 Jan 5. doi:10.25259/SNI_1013_2021
  • Clagett GP, Patterson CB, Fisher DF Jr, et al. Vein patch versus primary closure for carotid endarterectomy. A randomized prospective study in a selected group of patients. J Vasc Surg. 1989;9(2):213-223. doi:10.1067/mva.1989.vs0090213

Karotis endarterektomide geleneksel yöntemlerin canlandırılması: primer kapatma tekniklerinin kapsamlı bir incelemesi

Year 2025, Volume: 18 Issue: 3, 6 - 6
https://doi.org/10.31362/patd.1565193

Abstract

Amaç: Karotid endarterektomi (KEA), karotid arter hastalığının tedavisinde önemini korurken, son zamanlarda birincil kapatma tekniklerine olan ilgi artmıştır. Bu çalışma, geleneksel yöntemlerle karşılaştırıldığında birincil kapatmanın sonuçlarını, etkinliğini ve güvenliğini araştırmaktadır.
Gereç ve yöntemler: Ocak 2018 ile Nisan 2024 tarihleri arasında kliniğimizde primer kapatma ile KEA uygulanan 130 hastanın retrospektif analizi yapıldı. Tüm ameliyatlar genel anestezi altında standart bir prosedür izledi. Hastaların demografik özellikleri, ameliyat süresi, kros klemp süresi, mortalite, morbidite ve hastanede kalış süresiyle ilgili veriler toplandı. Takip değerlendirmeleri ameliyattan 1, 6 ve 12 ay sonra gerçekleştirildi.
Bulgular: Çalışmaya 90 erkek (%69) ve 40 kadın (%31) olmak üzere toplam 130 hasta dahil edildi. Hastaların ortalama yaşı 69,54±5,42 yıldı. Takiplerin 12. ayında, asemptomatik olarak 5 hastada (%3) restenoz gelişti. Postoperatif dönemde 3 hastada geçici iskemik atak (TIA) görüldü ve bu ataklar bir ay içinde tamamen düzeldi. Önemli olarak, bir aylık takip süresi boyunca hiçbir erken ölüm vakası bildirilmedi.
Sonuç: KEA'da primer kapatma tekniği, düşük restenoz ve postoperatif komplikasyon oranları ile erken mortalite olmaması bakımından umut verici sonuçlar ortaya koymaktadır. Bu bulgular, primer kapatma tekniğinin KEA’da avantajlı bir yaklaşım olabileceğini göstermektedir. Yöntemin doğrulanması ve optimize edilmesi amacıyla daha fazla araştırma ve prospektif çalışmalar gereklidir, böylece karotis arter hastalığının yönetiminde hasta sonuçları iyileştirilebilir.

References

  • Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis [published correction appears in N Engl J Med. 2010 Jul 29;363(5):498] [published correction appears in N Engl J Med. 2010 Jul 8;363(2):198]. N Engl J Med. 2010;363(1):11-23. doi:10.1056/NEJMoa0912321
  • Grotta JC. Clinical practice. Carotid stenosis. N Engl J Med. 2013;369(12):1143-1150. doi:10.1056/NEJMcp1214999
  • Howell SJ. Carotid endarterectomy. Br J Anaesth. 2007;99(1):119-131. doi:10.1093/bja/aem137
  • Byrne J, Feustel P, Darling RC 3rd. Primary closure, routine patching, and eversion endarterectomy: what is the current state of the literature supporting use of these techniques?. Semin Vasc Surg. 2007;20(4):226-235. doi:10.1053/j.semvascsurg.2007.10.006
  • Cheng I, Vyas KS, Velaga S, Davenport DL, Saha SP. Outcomes of Carotid Endarterectomy with Primary Closure. Int J Angiol. 2017;26(2):83-88. doi:10.1055/s-0037-1601053
  • Naylor AR, Sayers RD, McCarthy MJ, et al. Closing the loop: a 21-year audit of strategies for preventing stroke and death following carotid endarterectomy. Eur J Vasc Endovasc Surg. 2013;46(2):161-170. doi:10.1016/j.ejvs.2013.05.005
  • Rerkasem A, Orrapin S, Howard DP, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2020;9(9):CD001081. Published 2020 Sep 12. doi:10.1002/14651858.CD001081.pub4
  • North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445-453. doi:10.1056/NEJM199108153250701
  • Hobson RW 2nd, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med. 1993;328(4):221-227. doi:10.1056/NEJM199301283280401
  • Norton LW, Spencer FC. Long-term comparison of vein patch with direct suture. Technique of anastomosis of small arteries. Arch Surg. 1964;89:1083-1088. doi:10.1001/archsurg.1964.01320060151027
  • Rockman CB, Halm EA, Wang JJ, et al. Primary closure of the carotid artery is associated with poorer outcomes during carotid endarterectomy. J Vasc Surg. 2005;42(5):870-877. doi:10.1016/j.jvs.2005.07.043
  • Kapoor R, Evins AI, Marcus J, Rigante L, Kubota M, Stieg PE. Selective Patch Angioplasty and Intraoperative Shunting in Carotid Endarterectomy: A Single-Center Review of 141 Procedures. Cureus. 2015;7(10):e367. Published 2015 Oct 28. doi:10.7759/cureus.367
  • Hertzer NR, Beven EG, O'Hara PJ, Krajewski LP. A prospective study of vein patch angioplasty during carotid endarterectomy. Three-year results for 801 patients and 917 operations. Ann Surg. 1987;206(5):628-635. doi:10.1097/00000658-198711000-00013
  • White CJ. Carotid artery stenting. J Am Coll Cardiol. 2014;64(7):722-731. doi:10.1016/j.jacc.2014.04.069
  • International Carotid Stenting Study investigators, Ederle J, Dobson J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial [published correction appears in Lancet. 2010 Jul 10;376(9735):90. Nasser, H-C [corrected to Nahser, H-C]]. Lancet. 2010;375(9719):985-997. doi:10.1016/S0140-6736(10)60239-5
  • Bonati LH, Dobson J, Featherstone RL, et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015;385(9967):529-538. doi:10.1016/S0140-6736(14)61184-3
  • Sternbergh WC 3rd, Crenshaw GD, Bazan HA, Smith TA. Carotid endarterectomy is more cost-effective than carotid artery stenting. J Vasc Surg. 2012;55(6):1623-1628. doi:10.1016/j.jvs.2011.12.045
  • Kilaru S, Korn P, Kasirajan K, et al. Is carotid angioplasty and stenting more cost effective than carotid endarterectomy?. J Vasc Surg. 2003;37(2):331-339. doi:10.1067/mva.2003.124
  • Zagzoog N, Elgheriani A, Attar A, et al. Comprehensive comparison of carotid endarterectomy primary closure and patch angioplasty: A single-institution experience. Surg Neurol Int. 2022;13:1. Published 2022 Jan 5. doi:10.25259/SNI_1013_2021
  • Clagett GP, Patterson CB, Fisher DF Jr, et al. Vein patch versus primary closure for carotid endarterectomy. A randomized prospective study in a selected group of patients. J Vasc Surg. 1989;9(2):213-223. doi:10.1067/mva.1989.vs0090213
There are 20 citations in total.

Details

Primary Language English
Subjects Neurosciences (Other)
Journal Section Research Article
Authors

Oğuz Arslantürk 0000-0002-4047-9656

Emrah Keskin 0000-0001-5326-741X

Early Pub Date December 19, 2024
Publication Date
Submission Date October 11, 2024
Acceptance Date December 16, 2024
Published in Issue Year 2025 Volume: 18 Issue: 3

Cite

AMA Arslantürk O, Keskin E. Revitalizing traditional carotid endarterectomy methods: A comprehensive review of primary closure techniques. Pam Med J. December 2024;18(3):6-6. doi:10.31362/patd.1565193

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