Eversion Carotid Endarterectomy: A Safe, Advantageous Alternative to Conventional Carotid Endarterectomy

Abstract

Objective: To compare the results and time and cost efficacy of eversion carotid endarterectomy (ECEA) with standard carotid endarterectomy (SCEA). Methods: A retrospective analysis of 88 carotid endarterectomies performed by the residents under the guidance of the senior author between January 1, 1991, and December 31, 1993, was done. Fifty-five patients underwent SCEA (44 vein patch, 11 primary closure) and 33 had ECEA. The two groups were compared for operative time, intraoperative evaluation, cost, immediate and delayed morbidity, and restenosis (> 50%). Results: The two groups were found to be similar for age, sex ratio, and associated diseases. The indications for surgery were transient ischemic attack (TIA) (57% ECEA, 64% SCEA), previous stroke with minimal residual deficit (9% ECEA, 17% SCEA), and asymptomatic high-grade stenosis (34% ECEA, 19% SCEA). The average operative time for ECEA was significantly less (99.2 vs 135.2 minutes, P < 0.02). The mean blood loss was also less for ECEA (86 vs 181 cc). Two SCEA patients had immediate postoperative thrombosis resulting in 1 cerebrovascular accident (CVA) (1.8%), and 3 SCEA patients had cranial nerve injuries. In follow-up, 1 patient with SCEA had restenosis and 1 had a CVA unrelated to carotid disease. Morbidity associated with ECEA included 1 unsuccessful ECEA requiring interposition vein grafting and 1 intraoperative repair of an intimal flap. There was no associated residual morbidity. There was no significant difference in stroke rate between the two groups. The operative cost (excluding surgeon fee) was 28% higher for SCEA patients. Conclusion: Eversion carotid endarterectomy is a safe procedure and can be an important addition to a surgeon's armamentarium in efforts to cut costs while maintaining quality.

Durability of eversion carotid endarterectomy: Comparison with primary closure and carotid patch angioplasty

“…[10][11][12] Since the development of the modified eversion CEA procedure currently in use, a number of recent studies have demonstrated the feasibility of eversion CEA and reported clinical results comparable to the more widely used conventional CEA techniques. [5][6][7][8][9][13][14][15][16][17][18][19][20][21][22][23] Despite some potential advantages, many vascular surgeons remain hesitant, however, to include eversion CEA among their treatment options. The current study was undertaken to evaluate the results of introducing eversion CEA into a typical, well-established vascular surgery practice in a pragmatic manner without limiting the breadth of case selection or the individual surgeons' choice of CEA technique.…”

“…Recent studies indicate that eversion CEA achieves clinical results comparable to those of traditional methods, and its more normal postoperative hemodynamic characteristics may lower carotid restenosis rates. [13][14][15][16][17][18][19][20][21][22][23][24] This study was undertaken to compare the technical performance, operative results, and durability of eversion CEA to those of conventional CEA with primary arteriotomy closure and prosthetic patch Over the past 45 years a number of technical innovations have been introduced to improve the clinical results and long-term durability of carotid endarterectomy (CEA). In particular, three distinct techniques for performing closure of the CEA arteriotomy have evolved.…”

Eversion versus conventional carotid endarterectomy: Late results of a prospective multicenter randomized trial

“…Eversion CEA prevents the longitudinal arteriotomy of the internal carotid artery, provides optimal correction of an elongated internal carotid artery, and has been associated with low restenosis rates. [5][6][7][8][9][10][11][12][13][14] The EVEREST (EVERsion carotid Endarterectomy versus Standard Trial) was designed to evaluate the feasibility and durability of eversion CEA.…”

Standard duplex criteria overestimate the degree of stenosis after eversion carotid endarterectomy

“…[24][25][26][27][28][29][30] The eversion technique enjoys the potential advantages of requiring less time in the operating room because of a shorter suture line as well as not requiring the implantation of a prosthetic, homograft, or vein patch, which requires an incision in the leg to obtain autologous saphenous vein. Prosthetic or homograft patches have additional associated cost and might be more susceptible to infection.…”