Advanced carotid disease in patients requiring aortic reconstruction

Thomas C. Bower, Steven W. Merrell, Kenneth J. Cherry, Barbara J. Toomey, John W. Hallett, Peter Gloviczki, James M Naessens, Peter C. Pairolero

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Perioperative stroke is a devastating complication of abdominal aortic operations. Patients requiring aortic reconstruction with advanced carotid occlusive disease pose a particularly challenging management problem regarding timing of operations. All patients (n=121) undergoing both carotid artery endarterectomy (CEA) and abdominal aortic reconstruction (AAR) within 1 year of each other between 1979 and 1989 were reviewed. The sequence of operation was analyzed to determine its effect on early and late outcome. CEA was the first operation in 99 patients (group I); AAR was performed first in 22 patients (group II). Age, gender, number, types of risk factors, and associated medical problems were similar in both groups. Indications for CEA were: transient ischemic attacks (TIAs), recent ipsilateral stroke, or high-grade asymptomatic carotid artery stenosis exceeding 80%. Indications for aortic operation included: abdominal aortic aneurysm, aortoiliac occlusive disease, and combined aortic and renovascular disease. There were five perioperative strokes, two in group I (2%) and three in group II (14%) (p<0.04). All strokes occurred after AAR. There were five perioperative deaths (4%), four in group I (4%) and one in group II (5%). Overall survival was significantly greater in group I compared to group II (p <0.04); 5-year survival was 77% and 51% respectively. Multivariate analysis demonstrated age, hypertension, and diabetes to adversely affect survival; CEA as the first procedure, however, had a protective effect. Importantly, eight strokes occurred in group I in late follow-up, but only one was ipsilateral to the CEA. We conclude that CEA in selected patients who require AAR is safe, and, when performed prior to abdominal aortic repair, reduces perioperative stroke and may improve long-term survival.

Original languageEnglish (US)
Pages (from-to)146-151
Number of pages6
JournalThe American Journal of Surgery
Volume166
Issue number2
DOIs
StatePublished - 1993
Externally publishedYes

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Carotid Endarterectomy
Carotid Arteries
Stroke
Survival
Aortic Diseases
Carotid Stenosis
Transient Ischemic Attack
Abdominal Aortic Aneurysm
Multivariate Analysis
Hypertension

ASJC Scopus subject areas

  • Surgery

Cite this

Bower, T. C., Merrell, S. W., Cherry, K. J., Toomey, B. J., Hallett, J. W., Gloviczki, P., ... Pairolero, P. C. (1993). Advanced carotid disease in patients requiring aortic reconstruction. The American Journal of Surgery, 166(2), 146-151. https://doi.org/10.1016/S0002-9610(05)81046-3

Advanced carotid disease in patients requiring aortic reconstruction. / Bower, Thomas C.; Merrell, Steven W.; Cherry, Kenneth J.; Toomey, Barbara J.; Hallett, John W.; Gloviczki, Peter; Naessens, James M; Pairolero, Peter C.

In: The American Journal of Surgery, Vol. 166, No. 2, 1993, p. 146-151.

Research output: Contribution to journalArticle

Bower, TC, Merrell, SW, Cherry, KJ, Toomey, BJ, Hallett, JW, Gloviczki, P, Naessens, JM & Pairolero, PC 1993, 'Advanced carotid disease in patients requiring aortic reconstruction', The American Journal of Surgery, vol. 166, no. 2, pp. 146-151. https://doi.org/10.1016/S0002-9610(05)81046-3
Bower TC, Merrell SW, Cherry KJ, Toomey BJ, Hallett JW, Gloviczki P et al. Advanced carotid disease in patients requiring aortic reconstruction. The American Journal of Surgery. 1993;166(2):146-151. https://doi.org/10.1016/S0002-9610(05)81046-3
Bower, Thomas C. ; Merrell, Steven W. ; Cherry, Kenneth J. ; Toomey, Barbara J. ; Hallett, John W. ; Gloviczki, Peter ; Naessens, James M ; Pairolero, Peter C. / Advanced carotid disease in patients requiring aortic reconstruction. In: The American Journal of Surgery. 1993 ; Vol. 166, No. 2. pp. 146-151.
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