Carotid Screening with Duplex Ultrasound in Elderly Asymptomatic Patients Referred to a Vascular Surgeon: Is It Worthwhile?

Ascher, Enrico; DePippo, Patrick; Salles-Cunha, Sérgio X.; Marchese, Jennifer; Yorkovich, William

doi:10.1007/s100169900235

Cited by 27 publications

(17 citation statements)

References 21 publications

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“…7 This discrepancy may be explained by the fact that asymptomatic significant carotid stenosis occurs in elderly patients (age $ 65 years) with peripheral vascular disease. 5,6,8,17,20,21 However, the mean age of the patients in the present study was lower (∼58 years).…”

Section: Discussioncontrasting

confidence: 60%

“…This finding is in contrast to that of previous studies disclosing a prevalence of greater than 70% carotid stenosis ranging 5%-24% in patients suffering from peripheral vascular disease. [4][5][6]8,[17][18][19][20][21][22][23] In a meta-analysis of nineteen studies, Ahmed and Al-Khaffaf concluded that prevalence of .70% asymptomatic carotid artery stenosis was 14% in patients with peripheral vascular disease. 7 This discrepancy may be explained by the fact that asymptomatic significant carotid stenosis occurs in elderly patients (age $ 65 years) with peripheral vascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…4,17,20 In contrast, the majority of the previous studies found a link between age, as a predicting risk factor, and asymptomatic significant carotid artery stenosis. 5,6,8,21,23,27,28 Alexandrova et al found significant correlations between all risk factors (sex, age, diabetes mellitus, smoking, and hypertension) and the disease severity. 5 Simons et al 28 and Kurvers et al 23 indicated a significant association between low diastolic blood pressure and carotid artery stenosis.…”

Section: Dovepressmentioning

confidence: 99%

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Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

Shaafi

Shakeri

Ghabilli

2013

Journal of the Neurological Sciences

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Background: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial. Objectives: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA) stenosis in a group of Iranian patients with peripheral arterial disease. Methods: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged $50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs) and the origins of the internal and external arteries were scanned with B-mode ultrasonogaphy. Significant ICA stenosis, .70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was $3.5. Results: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six patients had a history of coronary artery disease, six patients had hypertension, and ten patients had diabetes mellitus. Significant ICA stenosis was present in four patients (4.2%) with peripheral arterial disease in one healthy individual (1%) of the control group (P . 0.05). In terms of the risk factors for atherosclerosis, no statistically significant relationship was found between individual atherosclerotic risk factors and significant ICA stenosis (P . 0.05). Conclusion:The prevalence of significant ICA stenosis in Iranian patients with peripheral arterial disease is low. In addition, there is no relationship between individual atherosclerotic risk factors and significant ICA stenosis.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

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Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

Shaafi

Shakeri

Ghabilli

2013

Journal of the Neurological Sciences

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“…Another study done by Ascher et al they examined findings of carotid DUS in 307 patients aged 65 years and older referred to a vascular surgeon for problems other than carotid disease [21]. They found that more than 20% has asymptomatic significant CAS and this finding was evident in elder males, smokers and diabetics.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Significant Carotid Artery Stenosis in Patients with Significant Atherosclerotic Peripheral Arterial Disease

Tm¹,

Aaew²,

Ghareeb³

2017

J Cardiovasc Dis Diagn

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Background: Peripheral arterial disease (PAD) and carotid occlusive disease (COD) are both known to be specific manifestations of atherosclerosis so can be correlated to each other. An important area of investigation is to identify those with significant carotid artery stenosis (CAS) to reduce the risk of cerebrovascular events. Duplex ultrasound scanning (DUS) is considered a valuable imaging modality to evaluate carotid arteries with high sensitivity and specificity and virtually non-existent hazards.

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“…1) The major risk factors are advanced age, male gender, smoking and diabetes mellitis. 2,3) To make stroke free survival carotid endarterectomy (CEA) is performed in asymptomatic and symptomatic patients with ≥70% and ≥50% stenosis of internal carotid artery respectively. 4,5) Perioperative strokes mostly are due to ipsilateral diseased carotid but some may be due to carotid artery clamping resulting in brain ischemia.…”

mentioning

confidence: 99%

Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: a Study of 122 Cases

Jamil

Rashid

Ghaffar

2016

Annals of Vascular Diseases

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Objectives:To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. Materials and Methods: A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year. Results: Shunt was used only in 5% (n = 6) patients. Of these, 2.5% (n = 3) patients were those who developed neurological symptoms on clamping the internal carotid and deployment of shunt resulted in complete resolution of symptoms. 2.5% (n = 3) had severe bilateral carotid stenosis and shunt was deployed. One of these patients developed stroke which was permanent. There was no mortality. The mean procedure time was 170 min in patients in whom shunt was used, when compared with 100 min in patients without shunt (P = 0.003). Conclusion: Use of shunt in carotid endarterectomy under local anesthesia as selective policy has an advantage in terms of cost effectiveness, operation time and prevention of potential complications.Keywords: shunt, carotid artery, surgery, local anesthesia, advantage in asymptomatic disease and higher in symptomatic patients. 1) The major risk factors are advanced age, male gender, smoking and diabetes mellitis. 2,3) To make stroke free survival carotid endarterectomy (CEA) is performed in asymptomatic and symptomatic patients with ≥70% and ≥50% stenosis of internal carotid artery respectively. 4,5) Perioperative strokes mostly are due to ipsilateral diseased carotid but some may be due to carotid artery clamping resulting in brain ischemia. 4) The duration of interrupted blood flow can be reduced by using a shunt to fulfill circulatory needs of the brain. CEA can be performed under local or general anesthesia with routine or selective use of shunt. 4,5) Potential disadvantage of using shunt during CEA include increase in operation time, dislodgement, bleeding, dissection of artery, tear in the artery wall, air or plaque embolism and increased local complications like nerve injury, infection, hematoma and long term stenosis. 6) However, reliable data is limited. 7) Selective use of shunt in cases of bilateral severe carotid artery occlusive disease and in those cases which developed neurological symptoms on clamping of carotid artery, can reduce shunt induced complications. 7) Keeping in view these international reviews and scarcity of guidelines in our national literature, we performed this study in our department with selective use of shunt to assess shunt related perioperative morbidity. Materials and MethodsAll consecutive patients reporting to the department of Vascular Surgery in Combined Military Hospital Lahore between January 2012 to January 2015; with documented narrowing of carotid artery occlusive disease, were included in this study. Of these, patients who were symptoma...

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Carotid Screening with Duplex Ultrasound in Elderly Asymptomatic Patients Referred to a Vascular Surgeon: Is It Worthwhile?

Cited by 27 publications

References 21 publications

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

Prevalence of Significant Carotid Artery Stenosis in Patients with Significant Atherosclerotic Peripheral Arterial Disease

Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: a Study of 122 Cases

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