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Carotid Artery Endarterectomy in Patients Over Seventy Years-of-Age

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      Carotid artery endarterectomy in the elderly patient has been considered to be a high risk procedure. Recent revaluation, however, showed that advanced age alone doesn't seem to increase the perioperative surgical risk. We retrospectively reviewed the records for 222 carotid artery endarterectomies, not combined with any other type of surgery, in 195 patients over 70 years-of-age. Twenty-eight patients (14.3%) were asymptomatic, 43% were seen after transient ischemic attacks, 5.1% after reversible ischemic neurologic defects, and 37.4% after stroke. A standard operative protocol was followed. We used a shunt in 45.5% of patients, a standard endarterectomy was performed in 93% of patients, using a patch in 68%. There were three perioperative deaths and seven perioperative strokes in the series; total combined morbidity and mortality was 5.1%. In the 73 patients operated after previous stroke, three died and five suffered a perioperative stroke; total combined morbidity and mortality was 10.9%. In the 122 patients operated after previous transient ischemic attack or asymptomatic, two suffered a perioperative stroke; total combined morbidity and mortality was 1.6%. Late survival was identical to the survival of a normal Belgian control population, and stroke and death-free ratio at five years was 65%, 52% for patients operated after previous stroke and 69% for asymptomatic patients or patients operated after transient ischemic attack. Carotid artery endarterectomy can be performed in patients over 70 years-of-age with perioperative results equal to those of younger patients.

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      References

      1. American Heart Association. Heart facts. Stroke 15, 1983.

        • Crawford ES
        • Crawford JL
        • Safi HJ
        • Coselli JS
        • Hess KR
        • Brooks B
        • Norton HJ
        • Glaeser DH
        Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients.
        J Vasc Surg. 1986; 3: 389-404
        • Kuan P
        • Bernstein SB
        • Ellestad MH
        Coronary artery bypass surgery morbidity.
        J Am Coll Cardiol. 1984; 3: 1391-1397
        • Smith JM
        • Lindsay WG
        • Lillehei RC
        • Nicoloff DM
        Cardiac surgery in geriatric patients.
        Surgery. 1976; 80: 443-448
        • Plecha FR
        • Bertin VJ
        • Plecha EJ
        • Avellone JC
        • Farrell CJ
        • Hertzer NR
        • Mayda J
        • Rhodes RS
        The early results of vascular surgery in patients 75 years of age and older: an analysis of 3259 cases.
        J Vasc Surg. 1985; 2: 769-774
        • Sundt TM
        • Sandok BA
        • Whissennant JP
        Carotid endarterectomy: complications and preoperative assessment of risk.
        Mayo Clin Proc. 1975; 50: 301-306
        • Benhamou AC
        • Kieffer E
        • Tricot JF
        • Maraval M
        • Lethoai H
        • Benhamou M
        • Boepsflug O
        • Natali J
        Carotid artery surgery in patients over 70 years-of-age.
        Int Surg. 1981; 66: 199-202
        • Ouriel K
        • Penn TE
        • Ricotta JJ
        • May AG
        • Green RM
        • Deweese JA
        Carotid endarterectomy in the elderly patient.
        Surg Gynecol Obstet. 1986; 162: 334-336
        • Hass JS
        An approach to the maximal acceptable stroke complication rate after surgery for transient cerebral ischemia.
        Stroke. 1979; 10: 104
      2. Hertzer NR. The risk of surgical and medical treatment of severe carotid stenosis. Presented at the Fifteenth Annual Symposium on current critical problems and new horizons in vascular surgery. New York, 1988.

      3. Moore WS. Current, immediate and long term results of surgery for asymptomatic lesions of the carotid artery. Fifteenth Annual Symposium on current critical problems and new horizons in vascular surgery. New York, 1988.

        • Kesteloot H
        • Geboers J
        • Joossens JV
        Nutrition and health.
        in: Yamori Y Lenfant C Prevention of cardiovascular diseases, an approach to active long life. Elsevier Science Publ, New York1978
        • Loftus CM
        • Biller J
        • Godersky JC
        • Adams HP
        • Yama T
        • Edwards PS
        Carotid endarterectomy in symptomatic elderly patients.
        Neurosurg. 1988; 22: 676-680
        • Vacanti G
        • Van Houten RJ
        • Hill RC
        A statistical analysis of the relationship of physical status to postoperative mortality.
        Anaesth Analg (Cleve). 1970; 49: 564-566
        • Morgan RF
        • Hirata RM
        • Jacques DA
        • Hoopes JE
        Head and neck surgery in the aged.
        Am J Surg. 1982; 144: 449-451
        • Cooperman M
        • Pflug B
        • Martin EW
        • Evans WE
        Cardiovascular risk factors in patients with peripheral vascular disease.
        Surgery. 1978; 84: 505-509
        • Rosenthal D
        • Rudderman RH
        • Jones DH
        • Clark MD
        • Stanton PE
        • Lamis PA
        • Daniels WW
        Carotid endarterectomy in the octogenarian: is it appropriate?.
        J Vasc Surg. 1986; 3: 782-787
        • Earnest F
        • Forbes G
        • Sandok BA
        • Piepgras DG
        • Faust RJ
        • Ilstrup DM
        • Arndt LJ
        Complications of cerebral angiography: prospective assessment of risk.
        AJNR. 1983; 4: 1191-1197
        • Mani RL
        • Eisenberg RL
        • McDonald EL
        • Pollock JA
        • Mani JR
        Complications of catheter cerebral arteriography: analysis of 5,000 procedures. I. Criteria and incidence.
        Am J Roentgenol. 1978; 131: 131-865
        • Rosenthal D
        • Zeichner WD
        • Lamis PA
        • Stanton PE
        Neurologic deficit after carotid endarterectomy: pathogenesis and management.
        Surgery. 1983; 94: 776-780
        • Richardson JD
        • Main KA
        Carotid endarterectomy in the elderly population: a statewide experience.
        J Vasc Surg. 1989; 9: 65-73
        • Rosenthal D
        • Stanton PE
        • Lamis PA
        • Daniels WW
        Carotid endarterectomy.
        Arch Surg. 1981; 116: 1569-1575
        • Moore WS
        • Yee JM
        • Hall AD
        Collateral cerebral blood pressure.
        Arch Surg. 1973; 106: 520-523