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Long-term Durability and Safety of Carotid Endarterectomy Closure Techniques

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Abstract

Background

Various techniques have been used for the execution of carotid endarterectomy; primary (PC), patch closure (CP) and eversion technique (ET).The superiority of any of them is still unproven. The aim of this study was to compare the long-term outcomes of each technique in terms of cerebrovascular event (CVE), restenosis, survival and major cardiac event (MACE).

Methods

Between 2007 and 2018, a retrospective analysis of prospectively recorded data from three European tertiary centers was undertaken including 1.357 patients. Demographics, comorbidities and medical treatment were analyzed in relation to long-term outcomes. Freedom from CVE, restenosis (> 70%), survival and MACE were estimated with Kaplan–Meier analysis curve.

Results

The mean age was 69.5 ± 8 (72% males;79% asymptomatic). 472 (35%) were treated with PC, 504 (37%) with CP and 381 (28%) with ET. Differences among groups were observed in age (P < 0.001), gender (P < 0.01), hypertension (P = 0.01), dyslipidemia (P < 0.001) and statin treatment (P < 0.001). The mean follow-up was 4.7 ± 3 years (median: 5 years). Seventy-three patients presented a CVE during 8 years of follow-up. The freedom from CVE including all techniques was 96% (SE 0.6%), 93% (SE 1%) and 89% (SE 1.6%), at 2, 5 and 8 years of follow-up, respectively, with no difference between groups (P .289). Freedom from restenosis was at 96% (SE 0.7%) and 89% (SE 5%) at 5 and 10 years, respectively, for all methods without differences. ET was associated with a higher mortality rate (P < 0.001) and MACE rate (P < 0.001).

Conclusions

Excellent outcomes were achieved with all types of closure techniques with low rates of MACE and other adverse events during long-term follow-up after CEA.

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Authors and Affiliations

  1. Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Greece

    Petroula Nana, Konstantinos Spanos, George Kouvelos & Athanasios Giannoukas

  2. Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varèse, Italy

    Gabriele Piffaretti & Matteo Tozzi

  3. Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia

    Igor Koncar, Petar Zlatanovic & Lazar Davidovic

Authors
  1. Petroula Nana
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  2. Konstantinos Spanos
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  3. Gabriele Piffaretti
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  4. Igor Koncar
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  5. George Kouvelos
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  6. Petar Zlatanovic
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  7. Matteo Tozzi
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  8. Lazar Davidovic
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  9. Athanasios Giannoukas
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Correspondence to Petroula Nana.

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Nana, P., Spanos, K., Piffaretti, G. et al. Long-term Durability and Safety of Carotid Endarterectomy Closure Techniques. World J Surg 44, 3545–3554 (2020). https://doi.org/10.1007/s00268-020-05604-0

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  • DOI: https://doi.org/10.1007/s00268-020-05604-0

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