Early and late results of carotid endarterectomy: retrospective study of 70 operations

Embolisations multiples des branches de l’artère ophtalmique : complication grave et encore méconnue des chirurgies faciales

We present a patient with ocular ischemia following autologous refined fat injection (lipostructure) into the glabellar area to treat wrinkles. We think this visual loss is directly a consequence of the surgery, by retrograde arteriolar microembolus into the ophthalmic artery via peripheral anastomoses with the arteries of the face. These complications are on the rise because of the esthetic facial injections of viscous materials. We explain the pathophysiology and present a review of the litterature.

[Carotid endarterectomy under regional anesthesia: follow-up of 104 patients]

Cervical carotid stenosis is one of the main causes of ischemic stroke. Carotid endarterectomy is a safe procedure for treatment of moderate and severe symptomatic and asymptomatic carotid stenosis. Regional anesthesia allows neurological evaluation of the patient during the surgery. We reviewed the results of 104 patients operated on at our institution under regional anesthesia during the period of April 1996 and May 2002. 64 patients were symptomatic (61.54%) and 40 asymptomatic (38.46%). All patients had carotid stenosis over 70%. The patients were followed from one to 72 months (Mean: 29.5). Three patients had cervical hematoma, that required surgical drainage. Two patients had minor stroke at the same side of the endarterectomy at the post-operative period and another two during the follow-up (1.92%). Two patients died due to complications related to the surgery (1.92%). Our results, compared with the literature, show that endarterectomy is a safe procedure to treat moderate or severe carotid artery stenosis.

Ring-stripping retrograde common carotid endarterectomy: case report

CONTEXT

Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy.

OBJECTIVE

To demonstrate the feasibility of retrograde common carotid endarterectomy.

DESIGN

Retrospective case report study.

SETTING

Tertiary care private hospital.

PARTICIPANTS

Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded.

MAIN MEASUREMENTS

Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency.

RESULTS

There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up.

CONCLUSION

There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.