A preliminary study was carried out on a population of twenty-five consecutive and unselected patients undergoing carotid endarterectomy. A matched control group of subjects suffering from same pathology, but unoperated, was compared to experimental sample. A battery of neuropsychological tests, the Zung Self-Rating Depression Scale and the Jachuck's Quality of Life Impairment Scale were administered one week before surgery, two weeks after (surgical sample only) and then eight months later. The research shows that carotid endarterectomy does not impair neuropsychological performances, but produces some improvement, reaching significant level in the case of Word Fluency 1 and Similarities tests; depressive scores remained substantially unchanged, while quality of life improved slightly.
Usually, the extension of revascularization of lower extremities to the distal arteries is performed to avoid limb amputation.Technical errors in the performance of the distal anastomosis or poor runoff cause early failure of the bypass; myointimal fibroplasia or new atherosclerosis at the distal suture edges cause long-term failure.A new modified technique was used in 20 patients to facilitate the performance of the distal anastomosis. A vein patch is employed to widen the distal arteriotomy, and then, the graft is sutured into the vein patch so that the caliber of the distal artery is increased; potential technical defects and the risk of an early thrombosis are thus avoided.Care is always taken to guarantee a backflow in the vessel, which will permit limb salvage even if the distal runoff is not maintained in long-term follow-up because of occlusion of the outflow.From 1979 to 1985, 20 patients underwent 21 distal arterial reconstructive procedures with this new technique. All patients presented an absolute indication for surgery: rest pain (6), gangrene or ulcer (12), and severe ischemia (2). For the bypass procedure, the great saphenous vein was employed in 13 cases and PTFE in 8. Three major amputations were necessary within eight days of the operation. There was no operative mortality. Long-term patency rate was very high (85%).
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