Modified Eversion Carotid Endarterectomy: A 14-Year Experience in a Tertiary Teaching University Hospital in Brazil (South America).

BACKGROUND: Carotid endarterectomy is one of the most performed vascular procedures. Since the first reports in the late 1950s, the conventional open and the eversion techniques are the popularized ones. A short extraction or partial eversion technique has been previously described and recently has been subjected to case series reports. The aim of the study was to present the experience of a teaching hospital with modified or partial eversion endarterectomy compared with the experience with conventional open procedure performed exclusively by training vascular surgeons.

METHOD: A retrospective review of a consecutive series of cases from January 2002 to June 2016 was performed.

RESULTS: There were 355 operations. The mean age was 70 years (range, 41-90), 72.39% were males, and 53.5% were symptomatic. There were 7.3% of contralateral occlusions and 12.1% of contralateral stenosis greater than 70%. General anesthesia was employed in 56% of cases and regional blockage in the remaining cases. A selective shunt was used in 10 patients among those operated with regional blockage (6.9%; 3.1% of the total group of patients) and 1 patient (0.5%) operated with general anesthesia. There were 73 open procedures with primary closure, 23 patch closures, and 259 partial eversion procedures. The mean operation time for the primary closure, patch closure, and eversion techniques were 129.9 min (range, 75-220), 137.5 min (range, 120-160), and 109.7 min (range, 45-230), respectively, with a significant difference (P < 0.0001, Kruskal-Wallis test). The mean clamping time for the same techniques was 23.5 min (range, 13-50), 42 min (range, 20-60), and 17.1 min (range, 9-41), respectively, with a significant difference (P < 0.0001, Kruskal-Wallis test). There were 2.25% of transient ischemic events, 2.54% of cerebrovascular accidents, 1.97% of death, and a combined death/cerebrovascular accidents rate of 3.94%, with no statistical difference between the surgical techniques. The incidence of neck hematoma was 5.63% and that of cranial nerve injury was 2.54%. There were 3.66% of patients submitted to late reoperation for restenosis. When results were analyzed according to the academic period of the last year of training, there was no difference regarding time and complications.

CONCLUSIONS: Modified or partial eversion endarterectomy seems to be safely performed and applicable for the teaching of new vascular surgeons.