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Perioperative blood pressure alterations after eversion and conventional carotid endarterectomy sustain in the midterm

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Abstract

Objective

Carotid endarterectomy (CEA) is associated with a profound effect on blood pressure. The aim of this study was to evaluate 24 h ambulatory blood pressure measurement (ABPM) after eversion (E-CEA) and conventional (C-CEA) endarterectomy including a midterm follow-up.

Methods

Seventy-one patients were included in this prospective study [E-CEA (37)/C-CEA (34)]. Daytime (8 a.m. to 10 p.m.) and nighttime (10 p.m. to 8 a.m.) ABPMs were analyzed perioperatively and at midterm after a median follow-up period of 9.5 months (interquartile range (IQR) 6.4–17.8) in the E-CEA group and 11.5 months (IQR 8.3–13.6) in the C-CEA group

Results

Patient demographics and preoperative antihypertensive regimens were similar in the two groups. Compared with baseline, ABPM decreased on postoperative day 1 in the C-CEA group (P < 0.01) but normalized by day three. By contrast, ABPM values were unchanged on day 1 in the E-CEA group but increased above baseline on day 3 (P < 0.01). E-CEA was associated with higher ABPM on day 1 (P < 0.001 daytime, P < 0.01 nighttime) and again on day 3 (P < 0.001 daytime, P < 0.01 nighttime). The use of vasodilators was more frequent in the E-CEA group, both in the recovery room (P = 0.007) and on the ward (P = 0.004). Midterm results showed no difference of average blood pressure values, but an increased maximal blood pressure (P = 0.01 daytime) and heart rate (HR) (P = 0.006 daytime) were reached in the E-CEA group and decreased HR (P = 0.01 nighttime) in the C-CEA group. Compared with baseline [(E-CEA: median (IQR) 2 (1–3); C-CEA: median (IQR) 2 (1–3)], the number of antihypertensive medications at midterm was significantly higher in the E-CEA group [(median (IQR) 3 (2–3) vs. 2 (2–3), P = 0.002)]. In both groups, no adverse cardiovascular or cerebrovascular events during follow-up could be observed.

Conclusion

Although the initial hypertensive effect of E-CEA diminishes during midterm follow-up, patients undergoing eversion endarterectomy keep needing more antihypertensive medications and are prone to develop higher maximal blood pressure.

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Funding

The company MAQUET GETINGE GROUP Cardiovascular (Fabrikstr. 35 in 64625 Bensheim, Germany) sponsored the device needed for ABPM (A&D® TM-2430 PC2, A&D® Tokyo 170-0013, Japan). An amount of 2,200 € was transferred. MAQUET was not involved in study design, data acquisition, statistical analysis of the data, and in writing the manuscript.

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None.

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Authors and Affiliations

  1. Department of Vascular and Endovascular Surgery, University Hospital of Ruprecht–Karls, Heidelberg, Germany

    Serdar Demirel, Nicolas Attigah, Maani Hakimi, Benedikta Burgmer & Dittmar Böckler

  2. Department of Vascular Surgery, Augsburg City Hospital, University of Ludwig-Maximillians, Munich, Germany

    Hans Bruijnen

Authors
  1. Serdar Demirel
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  2. Nicolas Attigah
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  3. Hans Bruijnen
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  4. Maani Hakimi
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  5. Benedikta Burgmer
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  6. Dittmar Böckler
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Correspondence to Serdar Demirel.

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Demirel, S., Attigah, N., Bruijnen, H. et al. Perioperative blood pressure alterations after eversion and conventional carotid endarterectomy sustain in the midterm. Langenbecks Arch Surg 398, 303–312 (2013). https://doi.org/10.1007/s00423-013-1048-7

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  • DOI: https://doi.org/10.1007/s00423-013-1048-7

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