Residual Infrarenal Aortic Neck following Endovascular and Open Aneurysm Repair

Abstract

Objectives:To determine the diagnostic value for predicting cerebral hyperperfusion syndrome (CHS) by adding a transcranial Doppler (TCD) measurement in the early postoperative phase after carotid endarterectomy (CEA).Design: Patients who underwent carotid endarterectomy between January 2004 and August 2010 and in whom both intra-and postoperative TCD monitoring were performed were included.Methods: In 184 CEA patients the mean velocity (V mean ) preoperatively (V 1 ), pre-clamping (V 2 ), post-declamping (V 3 ) and postoperatively (V 4 ) was measured using TCD. The intra-operative V mean increase ((V 3 Ϫ V 2 )/V 2 ) was compared to the postoperative increase ((V 4 Ϫ V 1 )/V 1 ) in relation to CHS. CHS was diagnosed if the patient developed neurological complaints in the presence of a preoperative V mean increase Ͼ100%.Results: Sixteen patients (9%) had an intra-operative V mean increase Ͼ100% and 22 patients (12%) a postoperative V mean increase of Ͼ100%. In 10 patients (5%) CHS was diagnosed; two of those had an intra-operative V mean increase of Ͼ100% and nine postoperative V mean increase Ͼ100%. This results in a positive predictive value of 13% for the intra-operative and 41% for the postoperative measurement.Conclusions: Besides the commonly used intra-operative TCD monitoring additional TCD measurement in the early postoperative phase is useful to more accurately predict CHS after CEA. Unselected Percutaneous Access with Large Vessel Closure for Endovascular