Experience of Carotid Endarterectomy and its Complications Under Superficial Cervical Block in Conscious Patients in a Tertiary Care Hospital

Aftab Ahmad Khan; Muhammad  Jamil; Khurram Shoaib  Khan; Shazadi  Ambreen

doi:10.51253/pafmj.v75iSUPPL-1.6521

Authors

Aftab Ahmad Khan Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Jamil Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Khurram Shoaib Khan Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shazadi Ambreen Department of Physiology, Shifa Tameer-e-Millat University Islamabad Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-1.6521

Keywords:

Carotid Endarterectomy, Post-operative Complications, Superficial Cervical Block.

Abstract

Objectives: To determine the frequency of post-operative complications of carotid endarterectomy conducted under superficial cervical block.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital, Rawalpindi, Pakistan Sep 2019 to Feb 2021.

Methodology: A total of 70 patients who reported to the Vascular Surgery Department, Combined Military Hospital, Rawalpindi Pakistan with an indication for carotid endarterectomy who met the sample selection criteria were included in this study. All patients underwent carotid endarterectomy and were followed up for subcutaneous and subplatysmal hematoma formation, the development of Neuropraxia, stroke and bleeding which required exploration for 4 weeks. Data was analyzed by SPSS 26.0.

Results: A total number of 10(14.3%) developed complications while 60(85.7%) surgeries were uneventful. Out of the total complications, hematomas accounted for 4(40%) of cases, while Neuropraxia and contralateral stroke accounted for 2(20%) of the cases each. Of the remaining two cases one developed myocardial infarction (MI) treated by cardiologist and discharged 5th postoperative day while the other required exploration for persistent hemorrhage.

Conclusion: Carotid endarterectomy under superficial cervical nerve block is a safe and effective procedure, with good outcomes.

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References

Khan MI, Khan JI, Ahmed SI, Haq U. The Epidemiology of stroke in a developing country (Pakistan). J Neurol Stroke. 2018; 8(1): 00275.

Arif, S., Nawaz, K., Hashmat, A., Alamgir, W., & Muham-mad, W. Burden of carotid artery disease in ischemic stroke patients with and without diabetes mellitus. Pak Armed Forces Med J, (2019) 69(4), 926-30.

Saha SP, Saha S, Vyas KS. Carotid Endarterectomy: Current concepts and practice patterns. Int J Angiol. 2015 Sep; 24(3): 223-35.

Zdrehuş C. Anaesthesia for carotid endarterectomy - general or loco-regional? Rom J Anaesth Intensive Care. 2015; 22(1): 17-24.

Kakisis JD, Antonopoulos CN, Mantas G, Moulakakis KG, Sfyroeras G, Geroulakos G. Cranial nerve injury after carotid endarterectomy: Incidence, risk factors, and time trends. Eur J Vasc Endovasc Surg. 2017 Mar; 53(3): 320-335.

GALA Trial Collaborative Group, Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, et al. General anaes-thesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet. 2008 Dec 20; 372(9656):2132-42.

Chiesa R, Melissano G, Castellano R, Tshomba Y, Marone EM, Civilini E, et al. Carotid endarterectomy: experience in 8743 cases. HSR Proc Intensive Care Cardiovasc Anesth. 2009;1(3): 33-45.

Bajawa, S., Haq, I. U., Masood, N., & Jameel, M.Advantages of carotid endarterectomy under local anes-thesia with minimal cerebral monitoring An experience of 45 cases. Pak Armed Forces Med J, (2014) 64(2), 190-95.

Avgerinos ED, Chaer RA, Naddaf A, El-Shazly OM, Marone L, Makaroun MS. Primary closure after carotid endarterec-tomy is not inferior to other closure techniques. J Vasc Surg. 2016 Sep; 64(3): 678-683.e1. https://doi: 10.1016/j.jvs.2016.03.415.

Cheng I, Vyas KS, Velaga S, Davenport DL, Saha SP. Out-comes of Carotid Endarterectomy with Primary Closure. Int J Angiol. 2017 Jun; 26(2): 83-88. https://doi: 10.1055/s-0037-1601053. Epub 2017 Mar 14. PMID: 28566933; PMCID: PMC5446247.

Myers SI, Valentine RJ, Chervu A, Bowers BL, Clagett GP. Saphenous vein patch versus primary closure for carotid endarterectomy: long-term assessment of a randomized pro-spective study. J Vasc Surg. 1994 Jan; 19(1): 15-22. https://doi: 10.1016/s0741-5214(94)70116-4.

Pappas D, Hines GL, Yoonah Kim E. Selective patching in carotid endarterectomy: is patching always necessary? J Cardiovasc Surg (Torino). 1999 Aug; 40(4): 555-9.

Adams HP Jr. Secondary prevention of atherothrombotic events after ischemic stroke. Mayo Clin Proc. 2009; 84(1): 43-51.

Houston Hearts: A history of cardiovascular surgery and medicine and the Methodist DeBakey Heart & Vascular Cen-ter Houston Methodist Hospital. Proc (Bayl Univ Med Cent). 2014; 27(4): 381-382.

Sacquegna T, D'Addato M, Baldrati A, Cortelli P, Lamieri C,Merlo Pich E, et al. Long-term prognosis after carotid endarterectomy. Eur Neurol.1986; 25(1): 369.

Press MJ, Chassin MR, Wang J, Tuhrim S, Halm EA. Predict-ing medical and surgical complications of carotid endarter-ectomy: Comparing the risk indexes. Arch Intern Med. 2006; 166(8): 914–920.

Kragsterman B, Logason K, Ahari A, Troëng T, Parsson H, Bergqvist D. Risk factors for complications after carotid endarterectomy--a population-based study. Eur J Vasc Endovasc Surg. 2004 Jul; 28(1): 98-103. https://doi: 10.1016/j.ejvs.2004.03.016.

Khan MM, Khan HM, Choudry UK, Kazmi TF, Amin A, Azeem SM. Carotid Endarterectomy: A Single Institutional Experience of 28 Years From Pakistan. Ann Vasc Surg. 2021 May; 73:566-570. https://doi: 10.1016/j.avsg.2020.12.059.

Tamaki T, Morita A. Neck haematoma after carotid endarterectomy: risks, rescue, and prevention. Br J Neuro-surg. 2019 Apr; 33(2): 156-160.

Cnotliwy M, Gasińska M, Petriczko W, Gutowski P, Szych Z. Trwałe miejscowe uszkodzenia nerwów po udroznieniu tet-nicy szyjnej wewnetrznej, Permanent local nerve injuries af-ter carotid endarterectomy. Wiad Lek. 2005; 58(7-8): 375-8. Polish.

Boulanger M, Camelière L, Felgueiras R, Berger L, Rerkasem K, Rothwell PM, et al. Peri-procedural myocardial infarction after carotid endarterectomy and stenting: Systematic review and meta-analysis. Stroke. 2015 Oct; 46(10): 2843-8.

Khattar NK, Friedlander RM, Chaer RA, Avgerinos ED, Kretz ES, Balzer JR, et al. Peri-operative stroke after carotid endarterectomy: etiology and implications. Acta Neurochir (Wien). 2016 Dec; 158(12): 2377-2383