Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#5. IS CLINICAL EXAM AN ADEQUATE PREDICTOR OF RESPIRATORY DYSFUNCTION AFTER BILATERAL CAROTID ENDARTERECTOMY
Paul B. Kreienberg, MD, R. Clement Darling, III, MD, Philip S.K. Paty, MD, Benjamin B. Chang, MD, William E. Lloyd, MD, and Dhiraj M. Shah, MD Albany Medical College Albany, NY
Purpose: One of the most feared complications when performing bilateral carotid endarterectomy on patients with bilateral high-grade stenosis is vocal cord paralysis with resultant respiratory dysfunction. This has led most surgeons to stage bilateral carotid endarterectomies by 4 to 6 weeks. The purpose of this study is to evaluate respiratory risks postoperatively in patients who have undergone bilateral carotid endarterectomy during the same admission with clinical exam to evaluate vocal cord function.
Methods and Materials: From January 1993 to January 1998, a total of 512 bilateral carotid endarterectomies were performed in 256 patients during a single admission. Data was collected prospectively; patient demographics, indications, and complications. Patients were evaluated after their first carotid endarterectomy by physical exam. Those patients with hoarseness were then examined by direct laryngoscopy to evaluate vocal cord paralysis. If there are no contraindications, patients had their contralateral carotid endarterectomy performed one day after their original procedure.
Results: There is an even amount of males and females in this study group, 20% were diabetic, and 32% were smokers. Operative indications included: 334 (73%) were asymptomatic, 71 (14%) had TIA's, 34 (6.6%) had amaurosis, and 33 (6.5%) had previous stroke. Operative mortality was 4 (1.6%). There was one permanent neurologic deficit and one cranial nerve injury after second carotid endarterectomy. Six patients had the second surgery delayed secondary to hoarseness, 4 with vocal cord dysfunction, and 10 (1.5%) had transient neurologic deficits that improved by discharge. No patient in this study period had respiratory collapse or was compromised after bilateral carotid endarterectomy during the same admission.
Conclusion: Bilateral carotid endarterectomy can be performed safely with acceptable results during one hospital admission. There does not appear to be an increased incidence of respiratory dysfunction after bilateral carotid endarterectomy that is performed during the same hospital admission. Clinical exam appears to be adequate in predicting respiratory and vocal cord dysfunction postoperatively.
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Last updated January 10, 1999