Comparison of primary suturing and dacron patch in carotid endarterectomy

Öz

Background: In carotid artery atherosclerotic disease; indications for intervention are accepted to be over 75% stenosis for asymptomatic patients and over 50% for symptomatic patients. Preferred surgical treatment is carotid endarterectomy. In this study, we compared clinical outcomes and ultrasonographic findings in two different surgical techniques of arteriotomy closure. The first technique consisted of primary suturing and the second is patch angioplasty with a dacron patch. In 6 month follow-up period clinical examinations and dupplex ultrasonography were performed and analyzed statistically.
Methods: 60 patients who underwent carotid endarterectomy for carotid artery disease between January 2017 and December 2020 were enrolled in the study. Data were obtained from hospital database and evaluated statistically. 30 arteriotomy incisions were closed primarily and 30 with dacron patch angioplasty. As surgical indication 50% stenosis in symptomatic patients and 70% stenosis in asymptomatic were determined. Postoperative complications were evaluated. After discharge one-week, two-month, six-month clinical examitanions were performed and in six-month follow up dupplex ultrasonography was performed by an independent radiology specialist, and these results were compared statistically.
Results: When the patients were evaluated in terms of postoperative complications, clinical follow-up after discharge, and 6-month Doppler ultrasonography, no significant differences were detected.
Conclusion: No statistically significant difference was found among techniques primary suturing and dacron patch angioplasty for stroke, occlusion and re-stenosis rates. According to short term results both techniques may be feasible for arteriotomy closure during carotid endarterectomy.

Anahtar Kelimeler

• Carotid endarterectomy
• stroke
• primary suturing
• dacron patch angioplasty

Karotis endarterektomide dacron yama ve primer kapatma yöntemlerinin karşılaştırılması

Öz

Amaç: Karotis arter hastalığında asemptomatik hasta için %75 ve üzeri darlıkta, semptomatik hasta için %50 ve üzeri darlıkta operasyon önerilir. Cerrahi olarak ise karotis endarterektomi yapılır. Yazımızda karotis endarterektomide primer kapatılan ve dacron yama ile kapatılan hastalardaki, postoperatif komlikasyonlar yönünden ve 6 aylık takipler açısından sonuçlarımızı değerlendirdik.
Gereç ve yöntem: 2017 ve 2020 yılları arasında karotis endarterektomi yapılan yapılan 60 hasta (38 erkek, 22 kadın) retrospektif olarak değerlendirildi. Çalışmaya alınan vakaların tamamı tek taraflı opere edilmiş olup, ameliyatların hepsi genel anestezi eşliğinde yapılmıştır. 30 hastanın karotis arteriotomisi primer kapatılmış, diğer 30 hastanın arteriotomileri dacron yama ile kapatılmıştır. Hastalarda ameliyat kriteri olarak semptomatik hastalarda %50 ve üzeri darlık, asmeptomatik hastalarda %75 ve üzeri darlık kabul edilmiştir. Hastalarda postoperatif komplikasyonlara bakıldı. Taburculuk sonrası 1. hafta,2. ay ve 6. aydaki kontrollerde klinik olarak değerlendirildi. 6. Ayda bağımsız bir radyolog tarafından yapılan doppler ultrasonografi sonuçlarındaki stenoz oranlarına bakıldı.
Bulgular: Hastalar da postoperatif komlikasyonlar, taburculuk sonrası klinik takiplerinde ve 6. ay doppler ultrasonografileri darlık açısından değerlendirildiğinde anlamlı farklılıklar tespit edilmedi.
Sonuç: Karotis endarterektomide primer kapatma ve dacron yama ile kapatma yötemlerinde postop restenoz açısından anlamlı istatiksel farklılıklar tespit edildi. Mevcut çalışmamızda iki kapatma yöntemininde güvenle tercih edilebileceği düşünülmektedir. Tabi ki daha büyük ölçekli çalışmalarda farklı sonuçlar çıkabileceği de unutulmamalıdır.
eceği düşünülmektedir. Tabi ki daha büyük ölçekli çalışmalarda farklı sonuçlar çıkabileceği de unutulmamalıdır.

Anahtar Kelimeler

• Karotis endarterektomi
• inme
• birincil dikiş
• dakron yama anjiyoplasti

Kaynakça

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