Working group:
Demographics and Treatment:
Thirty-two of the patients (n:44) were male (n:32 72.7%), and twelve (n:12 27.3%) were female. Mean age of male patients was 58.5±5.5 years (48-68), mean age of female patients was 64.5±3.3 years (60-68), mean age of all patients was 60.1±4.9 years (48- 66) was found. The surgically treated lesions were unilateral in all patients and were on the left in five patients (n:5 11%) and on the right side in thirty-nine patients (n:39 89%). Symptomatic carotid artery disease findings were detected in seven patients (n:7 15.9%), while the other patients were recorded as asymptomatic (n:37 84.1%). PTFE synthetic graft was preferred for patching in all patients.
When cardiac risk factors are examined; presence of atrial fibrillation was detected in only one (n:1 2.2% ) patient. Congestive heart failure was not present in any of our patients.
When peripheral artery disease risk factors are investigated;
1-Smoking history; While it was absent in female patients (n:0), it was present in twenty-five (n:25 78.1%) male patients, and in total 56.8% of patients in the study group.
2-Low-density lipoprotein (LDL) value of the patients: 162.16±40.3 mg/dl (110-256)
3-Hypertension (HT); were present in twenty patients (n:20 45.4%)
4-Diabetus Mellitus (DM); was present in twelve patients (n:12 27.2%).
Follow-up:
All patients were admitted to the cardiovascular intensive care unit after the operation. The cross-clamp time of the patients during the operation was calculated as 24.63±5.1 minutes (18- 45). In only three of the patients (n:3 6.8%), shunt was used during the operation. After the operation, ten (n:10 22.7%) of the patients had drainage from the drain system during the intensive care follow-up, and the mean drainage was 10.8±18.5cc (0-75cc), and the drains were removed 2 days after the operation when the drainage did not continue. Two patients (n:2 4.5%) had bleeding from the skin in the form of oozing at the wound site and the bleeding was stopped with a suture placed on the skin. No patient underwent revision (n:0).
Neurological examinations of the patients were performed after extubation; Facial slippage was detected in three patients (n:3 6.8%) and it was recorded that it disappeared spontaneously before the patient was discharged. The length of stay of the patients in the intensive care unit was recorded as 1.5±0.65 days (1-3 days) and the hospitalization period as 3.58±0.82 days (3-6 days). Hyperperfusion Syndrome, visual impairment due to retinal artery stenosis, and acute myocardial infarction in the postoperative period were not observed in any of the patients. No death or stroke was detected in any of the patients. Restenosis was investigated by imaging mostly with CDUS and CTA at day 10, third month, sixth month, and first year after discharge. At the end of the first year, restenosis was detected in a total of one patient (n: 2.2%), while stroke was not detected in any patient.
Control Group:
Demographics and Treatment:
Fifty-eight of the patients (n:82) were male (n:58 70.7%) and twenty-four (n:24 29.3%) were female. Mean age of male patients was 60.5±6.1 years (50-70), mean age of female patients was 65.2±3.6 years (58-70) and mean age of all patients was 61.8±5.3 years (50- 68) was found. The surgically treated lesions were unilateral in all patients and were on the left in fourteen patients (n:14 17%) and on the right side in 68 patients (n:68 83%). Twenty patients were registered as symptomatic (n:20 24.3%), and 62 patients were registered as asymptomatic (n:62 75.7%).
When cardiac risk factors are examined; presence of atrial fibrillation was detected in four (n:4 4.8%) patient. Congestive heart failure was not present in any of our patients.
When peripheral artery disease risk factors are investigated;
1-Smoking history; It was found in six (n:6 25%) female patients, thirty (n:30 51.7%) male patients, and 43.9% of the control group patients in totaly.
2-Low-density lipoprotein (LDL) value of the patients: 172.6±50.4 mg/dl (108-286)
3- Hypertension (HT); were present in twenty-eight patients (n:28 34.1%)
4-Diabetus Mellitus (DM); was present in nineteen patients (n:19 23.1%).
Follow-up:
All patients were admitted to the cardiovascular intensive care unit after the operation. The cross-clamp time of the patients during the operation was calculated as 20.5±4 minutes (15-36). Only seven of the patients (n:7 8.5%) had a shunt during the operation. Fourteen of the patients (n:14 17%) after the operation had drainage from the drain system during the intensive care follow-up, and the mean drainage was 9.2±12.8 (0-50cc), and the drains were removed 2 days after the operation when the drainage did not continue. Six patients (n:6 7.3%) had a small hematoma at the wound site, which was self-limiting and did not undergo surgical intervention and subsequently resorbed spontaneously. No patient underwent revision (n:0). Neurological examinations of the patients were performed after extubation; Facial slippage was detected in seven patients (n:7 8.5%) and it was recorded that it disappeared spontaneously before the patient was discharged. Mild redness occurred at the wound site in three patients (n:3.12.5%). The length of stay of the patients in the intensive care unit was recorded as 1.8±0.8 days (1-3 days) and the hospitalization times as 3.8±0.9 days (3-6 days). Hyperperfusion Syndrome was found in three patients (n:3 3.6%). In the postoperative period, retinal artery stenosis, acute myocardial infarction, death were not detected in the patients.
Restenosis was investigated by imaging mostly with CDUS and CTA at day 10, third month, sixth month, and first year after discharge. In the control examinations, two patients (n:2 2.5%) at the third month, five patients (n:5 6%) at the sixth month and six patients (n:6 7.3%) at the end of the first year, total (n:13). 15.8% restenosis was detected and recorded. Necessary treatments were applied to these patients. Postoperative stroke was detected in three patients (n:3 3.6%) who developed restenosis. Stroke after restenosis was detected in one patient in the third month, in one patient in the sixth month and in one patient in the first year.
Comparison of Groups:
When the groups were compared, it was seen that the patients were similar in terms of age, gender, location of carotid artery occlusion, presence of symptomatic carotid artery disease, duration of intensive care unit and hospital stay, postoperative complications and peripheral artery disease risk factors in terms of cross-clamp times during the operation. The most common peripheral artery risk factors in both the study group and the control group were smoking history and hypertension. Differently, three patients in the control group had Hyperperfusion Syndrome. Restenosis was found in only one of the patients in the study group (n:1 2.2%) and in thirteen (n:13 15.8%) patients in the control group. Stroke was not detected in any of the patients in the study group but stroke was detected in three of the thirteen patients who developed restenosis in the control group.
Demographic data and statistical comparison of the groups are shown in Table 1. The preoperative CTA image of one of our patients is shown in Image 1, the images of the operative endarterectomy and patch plasty with PTFA patch are shown in Image 2, and the CTA image of the same patient after discharge is shown in Image 3. Patients' intraoperative and postoperative findings shown in Table 2.
Table-1
Demographic data and findings of patients.
Table-2
Patients' intraoperative and postoperative findings.