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Wird die Karotischirurgie konkurrenzfähig bleiben?

Einfluss intraoperativer duplexsonographischer Qualitätskontrolle

Will carotid thromboendarterectomy remain competitive?

Influence of intraoperative duplex ultrasound quality control

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Zusammenfassung

Hintergrund

Thrombendarteriektomie (TEA) und interventionelles Stenten stehen im Wettbewerb in der Behandlung der Karotisläsion. Beide Verfahren müssen die Komplikationsraten mindern. Der Einfluss einer routinemäßigen intraoperativen duplexsonographischen Qualitätskontrolle sollte überprüft werden.

Methodik

In einer prospektiv fortlaufenden Studie mit 620 Eingriffen an 575 Personen, die zwischen 8/2001 und 12/2005 konsekutiv operiert wurden, wurde eine intraoperative Duplexsonographie vor Wundverschluss vorgenommen: 9,5% wiesen kontralateral eine signifikante Stenose, 6,7% einen Verschluss auf, 8,5% zeigten spezielle Läsionen. Eine Eversions-TEA erfolgte in 20,5%, eine TEA mit Patchplastik in 78,5%, eine Interposition in 1%. Die intraoperative Qualitätskontrolle zeigte in 10% Befunde, die eine Revision veranlassten.

Ergebnisse

Die kombinierte Morbiditäts-/Mortalitätsrate (MMR) lag bei 2,6% für das Gesamtkrankengut. Frauen wiesen mit 4,2% eine höhere MMR auf als Männer mit 1,9%. Patienten über 75 Jahre (n=151) zeigten ein erstaunlich niedriges Risiko. Im Gesamtkrankengut lag die neurologische Komplikationsrate bei 1,6%, die Rate schwerer Insulte bei 1,1%.

Zusammenfassung

Die intraoperative Duplexsonographie ermöglicht die frühzeitige Diagnose und rechtzeitige Korrektur einer gestörten Morphologie und Hämodynamik. Im Wettbewerb mit dem Stenten ist eine weitere Senkung der Komplikationsrate möglich und notwendig.

Abstract

Background

Thromboendarterectomy (TEA) and stenting are in competition for treatment of carotid artery lesions. Both treatment modalities have to improve significantly. The goal of the study was to evaluate the influence of routine intraoperative duplex ultrasound examination.

Methods

In a continuous prospective study, 575 patients underwent 620 carotid operations. Intraoperative duplex ultrasound examination was performed prior to wound closure: 9.5% had significant contralateral ICA stenoses and 6.7% ICA occlusion; 8.5% presented special lesions. An eversion TEA was performed in 20.5% while 78.5% underwent conventional TEA with patch plastyand graft interposition in 1%. Intraoperative quality control revealed unexpected lesions in 10% requiring immediate repair.

Results

The combined morbidity/mortality rate (MMR) of the total series was 2.6%. Women had an elevated risk (4.2%) in comparison to men (1.9%). The risk of elder patients (>75 years, n=151) was remarkably low. The neurological complication rate of the total series was 1.6% and the incidence of major strokes 1.1%.

Conclusions

Routine intraoperative duplex ultrasound examination of the carotid reconstruction allows early diagnosis and immediate correction of morphologic as well as hemodynamic lesions. Competing with stent placement a further reduction of complications of carotid TEA seems to be possible and necessary.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie und Phlebologie, Elisabeth-Krankenhaus Essen, Klara Kopp Weg 1, 45138, Essen, Deutschland

    H.W. Kniemeyer, C. Sporkmann, H. Beckmann, R. Martinez, A. Soliman & A. Pühler

  2. Ambulante Neurologie, Elisabeth-Krankenhaus Essen, Essen, Deutschland

    U. Sabin-Luzius

  3. Dept. of Vascular Surgery, Zagazig-University, Zagazig, Ägypten

    A. Salem

Authors
  1. H.W. Kniemeyer
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  2. C. Sporkmann
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  3. H. Beckmann
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  4. R. Martinez
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  5. U. Sabin-Luzius
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  6. A. Salem
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  7. A. Soliman
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  8. A. Pühler
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Correspondence to H.W. Kniemeyer.

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Kniemeyer, H., Sporkmann, C., Beckmann, H. et al. Wird die Karotischirurgie konkurrenzfähig bleiben?. Chirurg 78, 236–245 (2007). https://doi.org/10.1007/s00104-006-1287-z

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