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Eversion versus patch closed carotid endarterectomy : morbi -mortality one year after surgery

Eversion versus patch closed carotid endarterectomy : morbi -mortality one year after surgery. Introdução à Medicina I 2008/2009. Authors: Bárbara Soeiro; Joana Silva; Jorge Monteiro; Mafalda Barbosa; Marco Assunção; Pedro Tavares; Rodrigo Monteiro; Rosário Monteiro; Tiago Alves. Adviser:

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Eversion versus patch closed carotid endarterectomy : morbi -mortality one year after surgery

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  1. Eversionversus patch closed carotid endarterectomy: morbi-mortality one year after surgery Introdução à Medicina I 2008/2009 Authors: Bárbara Soeiro; Joana Silva; Jorge Monteiro; Mafalda Barbosa; Marco Assunção; Pedro Tavares; Rodrigo Monteiro; Rosário Monteiro; Tiago Alves Adviser: Prof. Sérgio Sampaio Class n. 20

  2. Background Stenosis of the internal carotid artery • Carotid stenosis is a narrowing of the lumen of the carotid artery, usually caused by atherosclerosis • Emboli to the cerebral arteries cause transient ischemic attack (TIA) or stroke

  3. Background Carotid Endarterectomy • Extraction of the inner lining of the carotid artery if it has become thickened or damaged.

  4. Background Carotid Stenosis ? Eversion Patch closure Carotid Endarterectomy

  5. Aim • Compare reports on: • mortality • neurological morbidity • risk of restenosis Eversion Patch closure vs Carotid Endarterectomy one year after surgery Meta-analysis

  6. Methods

  7. Methods Project Schedule and Gantt Chart

  8. Search Results Venn Diagram ISI Web of Knowledge 392 Total number of references: 1254 181 Elimination of repeated references 38 7 166 158 154 15 Pubmed 346 Scopus 516 Number of references: 719

  9. Methods Selection of Candidate Studies - Flowchart

  10. Review Results Candidate studies Total abstracts n=719 The study isn't a clinical and/or randomized controlled trial n=211 The abstract doesn't refer endarterectomy with Dacron patch closure or eversion n=280 The abstract doesn't refer post-operative neurological morbidity or mortality n=37 Revision through title and abstract The outcomes for both techniques aren't presented separately n=72 Candidate studies n=100 Follow-up wasn't higher than 1 year n=19

  11. Results Candidate studies • AbuRahma AF et al. Prospective randomized trial of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated dacron (hemashield) patching: Late follow-up. Ann Surg. 2003; 237(6):885-893. • AbuRahma AF et al. Prospective controlled study of carotid endarterectomy with hemashield patch: Is it thrombogenic? Vasc Surg. 2001; 35(3):167-174. • Ali T et al. Sequential cohort study of Dacron patch closure following carotid endarterectomy. Br J Surg. 2005; 92(3):316-321. • Archie JP. Carotid endarterectomy outcome with vein or dacron graft patch angioplasty and internal carotid artery shortening. J Vasc Surg. 1999; 29(4):654-664. • Archie Jr JP. Reoperations for carotid artery stenosis: Role of primary and secondary reconstructions. J Vasc Surg. 2001; 33(3):495-503. • Asciutto et al. Dacron patch infection after carotid angioplasty. A report of 6 cases. Eur J Vasc Endovasc Surg. 2007; 33(1):55-57. • Assadian et al. Homocysteine and early re-stenosis after carotid eversion endarterectomy. Eur J Vasc Endovasc Surg. 2007; 33(2):144-148. • Baker WH. Decreased recurrent carotid stenosis by routine patching and intraoperative scanning. Am Surg. 2001; 67(4):328-332. • Ballotta et al. Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: a prospective randomized study. Surgery. 2002; 131(3):287-293. • Ballotta et al. Carotid eversion endarterectomy: perioperative outcome and restenosis incidence. Ann Vasc Surg. 2002; 16(4):422-429. • Ballotta et al. Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study. Langenbecks Arch Surg. 2002; 387(5-6):216-221.

  12. Results Candidate studies • Ballotta E et al. Carotid endarterectomy and patch graft angioplasty vs carotid eversion endarterectomy. Early and long-term follow-up. Chirurgia. 1997; 10(1):62-67. • Ballotta E et al. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: a prospective randomized study. Surgery. 1999; 125(3):271-279. • Ballotta E and Da Giau G. Selective shunting with eversion carotid endarterectomy. J Vasc Surg. 2003 ;38(5):1045-1050. • Ballotta E et al. Diabetes and asymptomatic carotid stenosis: does diabetic disease influence the outcome of carotid endarterectomy? A 10-year single center experience. Surgery. 2008; 143(4):519-525. • Ballotta E et al. Carotid endarterectomy within 2 weeks of minor ischemic stroke: a prospective study. J Vasc Surg. 2008; 48(3):595-600. • Ballotta E et al. Long-term survival and stroke-free survival after eversion carotid endarterectomy for asymptomatic severe carotid stenosis. J Vasc Surg. 2007; 46(2):265-270. • Ballotta E et al. A prospective randomized study on bilateral carotid endarterectomy: patching versus eversion. Ann Surg. 2000; 232(1):119-125. • Balzer et al. Conventional thrombendarterectomy with patch-plasty vs, eversion endarterectomy: Technique, indication and results. Zentralblatt Fur Chirurgie.2000; 125(3):228-238. • Bernstein EF. Routine versus selective carotid patching. J Vasc Surg. 1992; 15(5):868-869. • Bhattacharya et al. A clinical comparison of Dacron patch closure of small-caliber carotids compared with primary closure of large-caliber carotids after endarterectomy. Am Surg. 1999; 65(4):378-382. • Blok JG et al. Vein patch rupture: early complication of carotid endarterectomy. Eur J Surg. 1995; 161(7):519-521. • Brothers TE. Initial experience with eversion carotid endarterectomy: absence of a learning curve for the first 100 patients. J Vasc Surg. 2005; 42(3):429-434. • Calaitges J et al. Eversion carotid endarterectomy: A safe, advantageous alternative to conventional carotid endarterectomy. A preliminary report. Vascular Surgery. 1996; 30(5):381-385.

  13. Results Candidate studies • Cao P et al. Eversion versus conventional carotid endarterectomy: a prospective study. Eur J Vasc Endovasc Surg. 1997; 14(2):96-104. • Cao P et al. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg. 2000; 31(1 Pt 1):19-30. • Cao P et al. A randomized study on eversion versus standard carotid endarterectomy - study design and preliminary results: the Everest Trial. J Vasc Surg. 1998; 27(4):595-605. • Cooley DA and Colosimo LR. Eversion technique for carotid endarterectomy. Surg Gynecol Obstet. 1993; 177(4):420-422. • Coppi G et al. Carotid endarterectomy using the classical technique and by eversion. [Endoarteriectomia carotidea con tecnica classica e per eversione.] Ann Ital Chir. 1997; 68(4):463-471. • Crawford RS et al. Carotid eversion endarterectomy and reimplantation: a safe and simple technique to prevent acute thrombosis-occlusion and/or early and late restenosis. Cardiovasc Surg. 1997; 5(5):473-480. • Crawford RS et al. Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg. 2007; 46(1):41-48. • Darling RC 3rd et al. Eversion carotid endarterectomy: a technical alternative that may obviate patch closure in women. Cardiovasc Surg. 2003; 11(5):347-352. • Darling RC 3rd et al. Eversion endarterectomy of the internal carotid artery: technique and results in 449 procedures. Surgery. 1996; 120(4):635-639. • De Syo D et al. Development of carotid endarterectomy at the sestre milosrdnice university hospital, zagreb (1970-1998) - what do we have to do now. Acta Clin Croat. 1998; 37(2):48-58. • Deriu G and De Francesco T. Rationale for using a patch graft in carotid endarterectomy. [Razionale dell'uso del patch nell'endoarteriectomia carotidea.]. Ann Ital Chir. 1997; 68(4):473-477. • Ecker RD et al. Durability of carotid endarterectomy. Stroke. 2003; 34:2941-2944.   • Economopoulos KJ et al. Comparison of carotid endarterectomy using primary closure, patch closure, and eversion techniques. Am J Surg. 1999; 178:505-510.

  14. Results Candidate studies • Entz L et al. Late results after eversion endarterectomy of the internal carotid artery. Magy Seb. 2001; 54:5-9. • Fearn SJ and McCollum CN. Shortening and reimplantation for tortuous internal carotid arteries. J Vasc Surg. 1998; 27:936-939. • Friedman SG. Clinical application of eversion carotid endarterectomy. Vasc Endovascular Surg. 2003; 37:239-244. • Garofalo M et al. Neurological complications in carotid endarterectomy. Minerva Cardioangiol. 1999; 47:121-126. • Gelabert HA et al. Carotid endarterectomy with primary closure does not adversely affect the rate of recurrent stenosis. Arch Surg. 1994; 129:648-654. • Goldman KA et al. A comparative study of saphenous vein, internal jugular vein, and knitted dacron patches for carotid artery endarterectomy. Ann Vasc Surg. 1995; 9:71-79. • Golledge J et al. Outcome of selective patching following carotid endarterectomy. Eur J Vasc Endovasc Surg. 1996; 11:458-463. • Green RM et al. Eversion endarterectomy of the carotid artery: Technical considerations and recurrent stenoses. J Vasc Surg. 2000; 32:1052-1061. • Green RM et al. The clinical course of residual carotid arterial disease. J Vasc Surg. 1991; 13:112-120. • Grego F et al. Is carotid endarterectomy in octogenarians more dangerous than in younger patients? J Cardiovasc Surg. 2005; 46(5):477-483. • Hagmuller GW et al. Operative management of carotid artery stenosis. Z Kardiol. 2004; 11:206-211 • Hertzer NR and Mascha EJ. A personal experience with coronary artery bypass grafting, carotid patching, and other factors influencing the outcome of carotid endarterectomy. J Vasc Surg. 2006; 43(5):959-968. • Hertzer NR et al. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg. 1997; 26(1):1-10. • Hertzer NR. The hidden statistics of carotid patch angioplasty. J Vasc Surg. 1994; 19(3):555-556.

  15. Results Candidate studies • Hugl B et al. Effect of age and gender on restenosis after carotid endarterectomy. Ann Vasc Surg. 2006; 20(5):602-608. • Iseli TA et al. Eversion carotid endarterectomy. ANZ J Surg. 2001; 71(10):570-573. • Jacobowitz GR et al. Long-term follow-up of saphenous vein, internal jugular vein, and knitted Dacron patches for carotid artery endarterectomy. Ann Vasc Surg. 2001; 15(3):281-287. • Janoušek L et al. Comparison of eversion and standard endarterectomy of internal carotid artery. [Srovnání everzní a klasické endarterektomie a. carotis interna]. Cesk Slov Neurol Neurochir. 2003; 66(3):203-205. • Jausseran JM et al. Carotid endarterectomy by the eversion method. One year arteriographical results. [Endarteriectomie carotidienne par eversion: Resultats radiologiques a un an]. J Mal Vasc. 1998; 23(1):7-12. • Jausseran JM et al. The advantages of perioperative arteriography in carotid surgery (POAC). Giornale Italiano di Chirurgia Vascolare. 1998; 5(2):90-95. • Johnson CA et al. Early recurrent carotid artery stenosis. Current Surgery. 1999; 56(7-8):420-422. • Johnson CA et al. The natural history of early recurrent carotid artery stenosis. Am J Surg. 1999; 177(5):433-436. • Jokinen JJ et al. Results and future of carotid endarterectomy in a medium-sized Finnish central hospital. Scand J Surg. 2006; 95(1):33-38. • Jones CE et al. Technical results from the eversion technique of carotid endarterectomy. Am Surg. 1996; 62(5):361-365. • Katras T et al. Durability of eversion carotid endarterectomy: comparison with primary closure and carotid patch angioplasty. J Vasc Surg. 2001; 34(3):453-458. • Katz SG and Kohl RD. Does the choice of material influence early morbidity in patients undergoing carotid patch angioplasty? Surgery. 1996; 119(3):297-301. • Kieny R et al. Evolution of carotid restenosis after endarterectomy. Cardiovasc Surg. 1994; 2(5):555-560. • Koskas F et al. Carotid eversion endarterectomy – short-term and long-term results. Ann Vasc Surg. 1995; 9:9-15.

  16. Results Candidate studies • Koskas F et al. Carotid eversion endarterectomy: short- and long-term results. Ann Vasc Surg. 1995; 9(1):9-15. • Kresowik TF et al. Improving the outcomes of carotid endarterectomy: results of a statewide quality improvement project. J Vasc Surg. 2000; 31(5):918-926. • Ladowski JS et al. Factors contributing to recurrent carotid disease following carotid endarterectomy. Am J Surg. 1997; 174(2):118-120. • LaMuraglia GM et al. Determinants of carotid endarterectomy anatomic durability: effects of serum lipids and lipid-lowering drugs. J Vasc Surg. 2005; 41(5):762-768. • Littooy FN et al. Comparison of standard carotid endarterectomy with Dacron patch angioplasty versus eversion carotid endarterectomy during a 4-year period. Am Surg. 2004; 70(2):181-185. • Liu CJ et al. Eversion carotid endarterectomy for carotid stenosis. Zhonghua Wai Ke Za Zhi. 2005; 43:409-411. • Marien BJ et al. Bovine pericardium vs dacron for patch angioplasty after carotid endarterectomy: a prospective randomized study. Arch Surg. 2002; 137(7):785-788. • Markovic DM et al. Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy. J Cardiovasc Surg (Torino). 2008; 49(5):619-25. • Mazzarolo G et al. Carotid surgery in patients over the age of 80 years: Own experience. Ric Sci 2 Ser Pt 2 Rend [B]. 2001; 22:75-79. • Mehta M et al. Eversion technique increases the risk for post-carotid endarterectomy hypertension. J Vasc Surg. 2001; 34(5):839-845. • Motyka M et al. Preventive eversion endarterectomy in patients with stenosis of the carotid artery imparing cerebral hemodynamics. Chir Narzadow Ruchu Ortop Pol. 2003; 5:97-102. • Naylor R et al. Randomized trial of vein versus dacron patching during carotid endarterectomy: long-term results. J Vasc Surg. 2004; 39(5):985-993.

  17. Results Candidate studies • Naylor R et al. Randomized trial of vein versus dacron patching during carotid endarterectomy: Long-term results. J Vasc Surg. 2004; 39(5):985-993. • Peiper C et al. Eversion endarterectomy versus open thromboendarterectomy and patch plasty for the treatment of internal carotid artery stenosis. Eur J Vasc Endovas Surg. 1999; 18(4):339-343. • Perler BA et al. Carotid dacron patch angioplasty: Immediate and long-term results of a prospective series. Cardiovasc Surg.1995; 3(6):631-636. • Pokrovskiǐ AV et al. Comparative analysis of carotid endarterectomy late outcomes related to intervention modality. Angiol Vasc Surg. 2005; 11(1):93-101. • Radak DJ et al. Temporal trends in eversion carotid endarterectomy for carotid atherosclerosis: Single-center experience with 5,034 patients. Vascular. 2007; 15(4):205-210. • Radak D et al. Single center experience on eversion versus standard carotid endarterectomy: A prospective non-randomized study. Cardiovasc Surg. 2000; 8(6):422-428. • Raithel D and Schunn C. Eversion endarterectomy - out? Zentralblatt Fur Chirurgie. 2000; 125(3):239-242. • Reigner B et al. Eversion endarterectomy of the internal carotid artery: Midterm results of a new technique. Ann Vascr Surg. 1995; 9(3):241-246. • Rockman CB et al. Primary closure of the carotid artery is associated with poorer outcomes during carotid endarterectomy. J Vasc Surg. 2005; 42(5):870-877. • Rosenthal D et al. Carotid patch angioplasty: immediate and long-term results. J Vasc Surg. 1990; 12(3):326-333. • Rush DS et al. The safety, efficacy, and durability of external carotid endarterectomy. J Vasc Surg. 1992; 16(3):407-413. • Schanzer et al. Restenosis after carotid endarterectomy performed with routine intraoperative duplex ultrasonography and arterial patch closure: a contemporary series. Vasc Endovascular Surg. 2007; 41(3):200-205.

  18. Results Candidate studies • Schneider JR et al. Carotid endarterectomy in women versus men: patient characteristics and outcomes. J Vasc Surg. 1997; 25(5):890-898. • Seelig MH et al. Use of intraoperative duplex ultrasonography and routine patch angioplasty in patients undergoing carotid endarterectomy. Mayo Clin Proc. 1999; 74(9):870-876. • Shah DM et al. Carotid endarterectomy by eversion technique. Adv Surg. 1999; 33:459-476. • Shah DM et al. Carotid endarterectomy by eversion technique: Its safety and durability. Ann Surg. 1998; 228(4):471-478. • Skelly CL et al. Routine early postoperative duplex scanning is unnecessary following uncomplicated carotid endarterectomy. Vasc Endovascular Surg. 2002; 36(2):115-122. • Szabo A et al. Long-term restenosis rate of eversion endarterectomy on the internal carotid artery. Eur J Vasc Endovasc Surg. 2004; 27(5):537-539. • Szabó A et al. Early rise in serum VEGF and PDGF levels predisposes patients with a normal MBL2 genotype to restenosis after eversion endarterectomy. Stroke. 2007; 38(8):2247-2253. • Thompson JM et al. Hemodynamics and anatomy after carotid endarterectomy: A comparison between two different surgical approaches. J Vasc Technol. 1998; 22(2):89-94. • Verhoeven BAet al. Closure of the arteriotomy after carotid endarterectomy: patch type is related to intraoperative microemboli and restenosis rate. J Vasc Surg. 2005 Dec;42(6):1082-1088. • Winkler GA et al.  Comparison of intraoperative completion flowmeter versus duplex ultrasonography and contrast arteriography for carotid endarterectomy. Vasc Endovascular Surg. 2006; 40(6):482-486. • Ziaja K et al. Treatment of critical stenosis of internal carotid artery in octogenarians. Chirurgia Polska. 2006; 8(1):27-32.

  19. Future Work Plan Project Schedule and Gantt Chart

  20. Future Work Plan Data Collection and Statistical Analysis • descriptive data • number of patients subject to the procedure of interest • age of patient • presence of neurological symptoms • methodologic data • randomized intervention • outcome data • death • stroke • transient ischemic attack • degree of stenosis Statistical Analysis

  21. References • Heberer G et al. “Enfermedades oclusivas crónicas de las arterias: Arteria carótida interna”. Enfermedades de la aorta y de las grandes arterias. Barcelona: Editorial Científico-Médica. 1970; 316-324. • DeBakey ME et al. Surgical considerations of occlusive disease of innominate, carotid, subclavian and vertebral arteries. Ann Surg 1959; 149:690-710. • Sumner DS. “Essential Hemodynamic Principles – Chapter 7”. Vascular Surgery [edited by] Robert B. Rutherford – 5th edition. Volume 1. Pennsylvania: W.B. Saunders Company. 2000; 78-79. • Hallett JW et al. “Cerebrovascular Disease – Chapter 11”. Handbook of Patient Care in Vascular Diseases – 4th Edition. Philadelphia: Lippincott Williams & Wilkins. 2001; 131-136. • Manuila L et al. Dicionário Médico. Lisboa: Climepsi Editores. 1999. • Hobson RW et al. Management of atherosclerotic carotid artery disease: Clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 2008; 48:480-486. • Messina LM and Stoney RJ. “Endarterectomy – Chapter 31”. Vascular Surgery [edited by] Robert B. Rutherford – 5th edition. Volume 1. Pennsylvania: W.B. Saunders Company 2000; 488-493. • Zarins CK and Gewertz BL. “Carotid artery surgery – Section I”. Atlas of Vascular Surgery – 2nd edition. Philadelphia: Elsevier. 2005; 3-13. • Byrne J et al. Primary closure, routine patching, and eversion endarterectomy: what is the current state of the literature supporting use of these techniques? Semin Vasc Surg 2007; 20:226-235.

  22. References • Cao P et al. A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the Everest Trial. J Vasc Surg 1998; 27:595-605. • Senning A. Developments in cardiac surgery in Stockholm during the mid and late 1950s. J Thorac Cardiovasc Surg 1989; 98:825-832. • Entz L et al. Comparison of perioperative results obtained with carotid eversion endarterectomy and with conventional patch plasty. Cardiovasc Surg 1997; 5:16-20. • Aburahma AF. Patch closure improves results with carotid endarterectomy. Semin Vasc Surg 2004; 17:243-252. • Aburahma AF et al. Prospective randomized trial of ACUSEAL (Gore-Tex) vs Finesse (Hemashield) patching during carotid endarterectomy: Long-term outcome. J Vasc Surg 2008; 48:99-103. • Ballotta E et al. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: a prospective randomized study. Surgery 1999; 125:271-279. • Crawford RS et al. Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg 2007; 46:41-48. • Cao P et al. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg 2000; 31:19-30.

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