Print this pageRetrojugular Carotid Endarterectomy –A Prospective study.
Authors: T Joseph, S J Robinson, E Grocott.
Institution: Worcestershire Royal Hospital, Worcester, UK.
Aim: To compare the safety and outcome of antejugular and retrojugular approach to carotid endarterectomy.
Methods: Consecutive patients who underwent carotid endarterectomy under single surgeon had their preoperative, operative and post-operative data collected prospectively which included 6-week review by the surgeon and neurologist.
Results: A total of 278 patients (189 men, 89 women) underwent carotid endarterectomy (156–antejugular, 122-retrojugular). Their median age was 71 years (range 40-89). There was no significant difference between the two groups on comparing the demographics, risk factors and indications except for number of pre-CABG-patients where the cohorts were small.
Table comparing operative-factors and complications.
|
|
Ante-jugular |
Retro-jugular |
p-value |
|
GA |
81(51.9%) |
28(22.9%) |
<0.001 |
|
LA |
75(48.1%) |
94(77.1%) |
<0.001 |
|
Patch |
31(19.9%) |
33(27.0%) |
0.227 |
|
Shunt |
85(55.5%) |
47(38.5%) |
0.036 |
|
Time for CEA (GA) |
109(24) |
88(22) |
<0.05 |
|
Time for CEA (LA) |
78(11) |
96(16) |
<0.05 |
|
Blood loss |
12(4) |
67(24) |
<0.001 |
|
Post-operative stroke |
4(2.6%) |
0 |
0.066 |
|
Cranial Nerve Injury |
4(2.6%) |
3(2.4%) |
0.672 |
-
Conclusion: Retro-jugular approach to carotid artery is safe and it is quicker to perform with significantly less blood-loss. It gives better exposure when higher dissection is necessary.