Eversion technique increases the risk for post-carotid endarterectomy hypertension

Manish Mehta, Omid Rahmani, Alan M. Dietzek, John Mecenas, Larry A. Scher, Steven G. Friedman, Toufic Safa, Takao Ohki, Frank J. Veith

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: The incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (e-CEA) was compared with that after standard carotid endarterectomy (s-CEA). Methods: In a retrospective analysis from January 1998 to January 2000, 217 patients underwent 219 CEAs for symptomatic (68) or asymptomatic (151) high-grade (>80%) carotid artery stenosis by either standard (137) or eversion (82) techniques. The eversion technique involves an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque. All procedures were done under general anesthesia, and somatosensory-evoked potentials were used for cerebral monitoring. Patients with s-CEA were compared with those with e-CEA for postoperative hemodynamic instability, carotid sinus nerve block, requirement for intravenous vasodilators or vasopressors, stroke, and death. Results: Patients who underwent e-CEA had a significantly (P < .005) increased postoperative blood pressure and required more frequent intravenous antihypertensive medication (24%), compared with patients having an s-CEA (6%). Furthermore, postoperative vasopressors were required after 10% of s-CEAs, but after none of the e-CEAs. No statistically significant difference was noted in the morbidity or mortality of patients after s-CEA and e-CEA. Conclusion: e-CEA is a substantial risk factor for HTN in the immediate postoperative period, when compared with the s-CEA. This difference would be even more remarkable in the absence of antihypertensive medications in the e-CEA group and vasopressors in the s-CEA group. Therefore, particular attention should be focused on diagnosing and controlling postoperative HTN in patients after e-CEA.

Original languageEnglish (US)
Pages (from-to)839-845
Number of pages7
JournalJournal of Vascular Surgery
Volume34
Issue number5
DOIs
StatePublished - Nov 2001

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Carotid Endarterectomy
Hypertension
Internal Carotid Artery
Antihypertensive Agents
Carotid Sinus
Endarterectomy
Somatosensory Evoked Potentials
Nerve Block
Carotid Stenosis
Atherosclerotic Plaques
Vasodilator Agents
Postoperative Period
General Anesthesia
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mehta, M., Rahmani, O., Dietzek, A. M., Mecenas, J., Scher, L. A., Friedman, S. G., ... Veith, F. J. (2001). Eversion technique increases the risk for post-carotid endarterectomy hypertension. Journal of Vascular Surgery, 34(5), 839-845. https://doi.org/10.1067/mva.2001.118817

Eversion technique increases the risk for post-carotid endarterectomy hypertension. / Mehta, Manish; Rahmani, Omid; Dietzek, Alan M.; Mecenas, John; Scher, Larry A.; Friedman, Steven G.; Safa, Toufic; Ohki, Takao; Veith, Frank J.

In: Journal of Vascular Surgery, Vol. 34, No. 5, 11.2001, p. 839-845.

Research output: Contribution to journalArticle

Mehta, M, Rahmani, O, Dietzek, AM, Mecenas, J, Scher, LA, Friedman, SG, Safa, T, Ohki, T & Veith, FJ 2001, 'Eversion technique increases the risk for post-carotid endarterectomy hypertension', Journal of Vascular Surgery, vol. 34, no. 5, pp. 839-845. https://doi.org/10.1067/mva.2001.118817
Mehta, Manish ; Rahmani, Omid ; Dietzek, Alan M. ; Mecenas, John ; Scher, Larry A. ; Friedman, Steven G. ; Safa, Toufic ; Ohki, Takao ; Veith, Frank J. / Eversion technique increases the risk for post-carotid endarterectomy hypertension. In: Journal of Vascular Surgery. 2001 ; Vol. 34, No. 5. pp. 839-845.
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abstract = "Objective: The incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (e-CEA) was compared with that after standard carotid endarterectomy (s-CEA). Methods: In a retrospective analysis from January 1998 to January 2000, 217 patients underwent 219 CEAs for symptomatic (68) or asymptomatic (151) high-grade (>80{\%}) carotid artery stenosis by either standard (137) or eversion (82) techniques. The eversion technique involves an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque. All procedures were done under general anesthesia, and somatosensory-evoked potentials were used for cerebral monitoring. Patients with s-CEA were compared with those with e-CEA for postoperative hemodynamic instability, carotid sinus nerve block, requirement for intravenous vasodilators or vasopressors, stroke, and death. Results: Patients who underwent e-CEA had a significantly (P < .005) increased postoperative blood pressure and required more frequent intravenous antihypertensive medication (24{\%}), compared with patients having an s-CEA (6{\%}). Furthermore, postoperative vasopressors were required after 10{\%} of s-CEAs, but after none of the e-CEAs. No statistically significant difference was noted in the morbidity or mortality of patients after s-CEA and e-CEA. Conclusion: e-CEA is a substantial risk factor for HTN in the immediate postoperative period, when compared with the s-CEA. This difference would be even more remarkable in the absence of antihypertensive medications in the e-CEA group and vasopressors in the s-CEA group. Therefore, particular attention should be focused on diagnosing and controlling postoperative HTN in patients after e-CEA.",
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AU - Mehta, Manish

AU - Rahmani, Omid

AU - Dietzek, Alan M.

AU - Mecenas, John

AU - Scher, Larry A.

AU - Friedman, Steven G.

AU - Safa, Toufic

AU - Ohki, Takao

AU - Veith, Frank J.

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N2 - Objective: The incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (e-CEA) was compared with that after standard carotid endarterectomy (s-CEA). Methods: In a retrospective analysis from January 1998 to January 2000, 217 patients underwent 219 CEAs for symptomatic (68) or asymptomatic (151) high-grade (>80%) carotid artery stenosis by either standard (137) or eversion (82) techniques. The eversion technique involves an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque. All procedures were done under general anesthesia, and somatosensory-evoked potentials were used for cerebral monitoring. Patients with s-CEA were compared with those with e-CEA for postoperative hemodynamic instability, carotid sinus nerve block, requirement for intravenous vasodilators or vasopressors, stroke, and death. Results: Patients who underwent e-CEA had a significantly (P < .005) increased postoperative blood pressure and required more frequent intravenous antihypertensive medication (24%), compared with patients having an s-CEA (6%). Furthermore, postoperative vasopressors were required after 10% of s-CEAs, but after none of the e-CEAs. No statistically significant difference was noted in the morbidity or mortality of patients after s-CEA and e-CEA. Conclusion: e-CEA is a substantial risk factor for HTN in the immediate postoperative period, when compared with the s-CEA. This difference would be even more remarkable in the absence of antihypertensive medications in the e-CEA group and vasopressors in the s-CEA group. Therefore, particular attention should be focused on diagnosing and controlling postoperative HTN in patients after e-CEA.

AB - Objective: The incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (e-CEA) was compared with that after standard carotid endarterectomy (s-CEA). Methods: In a retrospective analysis from January 1998 to January 2000, 217 patients underwent 219 CEAs for symptomatic (68) or asymptomatic (151) high-grade (>80%) carotid artery stenosis by either standard (137) or eversion (82) techniques. The eversion technique involves an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque. All procedures were done under general anesthesia, and somatosensory-evoked potentials were used for cerebral monitoring. Patients with s-CEA were compared with those with e-CEA for postoperative hemodynamic instability, carotid sinus nerve block, requirement for intravenous vasodilators or vasopressors, stroke, and death. Results: Patients who underwent e-CEA had a significantly (P < .005) increased postoperative blood pressure and required more frequent intravenous antihypertensive medication (24%), compared with patients having an s-CEA (6%). Furthermore, postoperative vasopressors were required after 10% of s-CEAs, but after none of the e-CEAs. No statistically significant difference was noted in the morbidity or mortality of patients after s-CEA and e-CEA. Conclusion: e-CEA is a substantial risk factor for HTN in the immediate postoperative period, when compared with the s-CEA. This difference would be even more remarkable in the absence of antihypertensive medications in the e-CEA group and vasopressors in the s-CEA group. Therefore, particular attention should be focused on diagnosing and controlling postoperative HTN in patients after e-CEA.

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