Transcript Diapositivo 1

Authors:
Bárbara Soeiro; Joana Silva; Jorge Monteiro; Mafalda
Barbosa; Marco Assunção; Pedro Tavares; Rodrigo
Monteiro; Rosário Monteiro; Tiago Alves
Adviser:
Prof. Sérgio Sampaio
Class n. 20
Introdução à Medicina I
2008/2009
Background
Stenosis of the internal carotid artery
• Carotid
stenosis
is
a
narrowing of the lumen of the
carotid artery, usually caused
by atherosclerosis
• Emboli to the cerebral arteries
cause transient ischemic attack
(TIA) or stroke
Background
Carotid Endarterectomy
Patch Closed
Carotid
endarterectomy
Eversion
• Extraction of the inner lining of
the carotid artery if it has become
thickened or damaged.
Background
Carotid Stenosis
Eversion
?
Patch closure
Carotid Endarterectomy
Aim
• Compare reports on:
• mortality
• neurological morbidity
• risk of restenosis
one year after surgery
Eversion
vs
Patch closure
Carotid Endarterectomy
Meta-analysis
Methods
Search Terms
carotid endarterectomy, mortality, stroke, transient ischemic
attack, restenosis, eversion, patch closure (or equivalent
terms).
Query algorithm
carotid AND (endarterectomy OR endarterectomies) AND
(eversion OR patch OR CEE OR CEER OR CEAP) AND
(mortality OR death OR "neurologic morbidity" OR stroke OR
"vascular accident" OR "brain vascular accident" OR
"cerebrovascular accident" OR CVA OR restenosis OR
"transient ischemic attack" OR “transient brainstem
ischemia" OR "cerebral ischemia" OR TIA)
Limits
Language: English
Published since 1990
Databases
PubMed
Scopus
ISI Web of Knowledge
Methods
Project Schedule and Gantt Chart
Search Results
Venn Diagram
ISI Web of Knowledge
392
Total number of references: 1254
181
Elimination
of
repeated
references
7
38
166
158
Number of references: 719
Scopus
516
154
15
Pubmed
346
Methods
Selection of Candidate Studies - Flowchart
Start
Article search on
databases
Search on
PubMed
N=346
Search on Isi Web
Knowledge
N=392
Search on Scopus
N=516
The article
is a clinical and/or
randomized controlled
trial
Yes
No
The abstract refers
endarterectomy with
Dacron patch closure
or eversion
No
Yes
The abstract
refers post-operative
neurological morbidity
or mortality
No
Excluded
Yes
The outcomes
for both tecniques are
presented
separately
No
Yes
Exclusion of
repetead articles
among the
databases
Abstract review
N=719
Follow-up was higher
than 1 year
No
Yes
Included
Division abtracts
into 5 groups with
2 revisers each
N=159/160
Stop
Write the time of
follow-up
Review Results
Candidate studies
Total abstracts
n=719
The study isn't a clinical and/or
randomized controlled trial
n=211
The abstract doesn't refer
endarterectomy with Dacron patch
closure or eversion
n=280
Revision
through title
and abstract
The abstract doesn't refer postoperative neurological morbidity or
mortality
n=37
The outcomes for both techniques
aren't presented separately
n=72
Follow-up wasn't higher than 1 year
n=19
Candidate studies
n=100
Results
Candidate studies
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
AbuRahma AF et al. Prospective randomized trial of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated
dacron (hemashield) patching: Late follow-up. Ann Surg. 2003; 237(6):885-893.
AbuRahma AF et al. Prospective controlled study of carotid endarterectomy with hemashield patch: Is it thrombogenic? Vasc Surg. 2001;
35(3):167-174.
Ali T et al. Sequential cohort study of Dacron patch closure following carotid endarterectomy. Br J Surg. 2005; 92(3):316-321.
Archie JP. Carotid endarterectomy outcome with vein or dacron graft patch angioplasty and internal carotid artery shortening. J Vasc Surg.
1999; 29(4):654-664.
Archie Jr JP. Reoperations for carotid artery stenosis: Role of primary and secondary reconstructions. J Vasc Surg. 2001; 33(3):495-503.
Asciutto et al. Dacron patch infection after carotid angioplasty. A report of 6 cases. Eur J Vasc Endovasc Surg. 2007; 33(1):55-57.
Assadian et al. Homocysteine and early re-stenosis after carotid eversion endarterectomy. Eur J Vasc Endovasc Surg. 2007; 33(2):144148.
Baker WH. Decreased recurrent carotid stenosis by routine patching and intraoperative scanning. Am Surg. 2001; 67(4):328-332.
Ballotta et al. Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: a prospective randomized study. Surgery.
2002; 131(3):287-293.
Ballotta et al. Carotid eversion endarterectomy: perioperative outcome and restenosis incidence. Ann Vasc Surg. 2002; 16(4):422-429.
Ballotta et al. Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study. Langenbecks Arch Surg.
2002; 387(5-6):216-221.
Results
Candidate studies
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Ballotta E et al. Carotid endarterectomy and patch graft angioplasty vs carotid eversion endarterectomy. Early and long-term follow-up.
Chirurgia. 1997; 10(1):62-67.
Ballotta E et al. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: a prospective
randomized study. Surgery. 1999; 125(3):271-279.
Ballotta E and Da Giau G. Selective shunting with eversion carotid endarterectomy. J Vasc Surg. 2003 ;38(5):1045-1050.
Ballotta E et al. Diabetes and asymptomatic carotid stenosis: does diabetic disease influence the outcome of carotid endarterectomy? A 10year single center experience. Surgery. 2008; 143(4):519-525.
Ballotta E et al. Carotid endarterectomy within 2 weeks of minor ischemic stroke: a prospective study. J Vasc Surg. 2008; 48(3):595-600.
Ballotta E et al. Long-term survival and stroke-free survival after eversion carotid endarterectomy for asymptomatic severe carotid stenosis.
J Vasc Surg. 2007; 46(2):265-270.
Ballotta E et al. A prospective randomized study on bilateral carotid endarterectomy: patching versus eversion. Ann Surg. 2000; 232(1):119125.
Balzer et al. Conventional thrombendarterectomy with patch-plasty vs, eversion endarterectomy: Technique, indication and results.
Zentralblatt Fur Chirurgie.2000; 125(3):228-238.
Bernstein EF. Routine versus selective carotid patching. J Vasc Surg. 1992; 15(5):868-869.
Bhattacharya et al. A clinical comparison of Dacron patch closure of small-caliber carotids compared with primary closure of large-caliber
carotids after endarterectomy. Am Surg. 1999; 65(4):378-382.
Blok JG et al. Vein patch rupture: early complication of carotid endarterectomy. Eur J Surg. 1995; 161(7):519-521.
Brothers TE. Initial experience with eversion carotid endarterectomy: absence of a learning curve for the first 100 patients. J Vasc Surg.
2005; 42(3):429-434.
Calaitges J et al. Eversion carotid endarterectomy: A safe, advantageous alternative to conventional carotid endarterectomy. A preliminary
report. Vascular Surgery. 1996; 30(5):381-385.
Results
Candidate studies
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
Cao P et al. Eversion versus conventional carotid endarterectomy: a prospective study. Eur J Vasc Endovasc Surg. 1997; 14(2):96-104.
Cao P et al. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg.
2000; 31(1 Pt 1):19-30.
Cao P et al. A randomized study on eversion versus standard carotid endarterectomy - study design and preliminary results: the Everest
Trial. J Vasc Surg. 1998; 27(4):595-605.
Cooley DA and Colosimo LR. Eversion technique for carotid endarterectomy. Surg Gynecol Obstet. 1993; 177(4):420-422.
Coppi G et al. Carotid endarterectomy using the classical technique and by eversion. [Endoarteriectomia carotidea con tecnica classica e
per eversione.] Ann Ital Chir. 1997; 68(4):463-471.
Crawford RS et al. Carotid eversion endarterectomy and reimplantation: a safe and simple technique to prevent acute thrombosisocclusion and/or early and late restenosis. Cardiovasc Surg. 1997; 5(5):473-480.
Crawford RS et al. Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg. 2007; 46(1):41-48.
Darling RC 3rd et al. Eversion carotid endarterectomy: a technical alternative that may obviate patch closure in women. Cardiovasc Surg.
2003; 11(5):347-352.
Darling RC 3rd et al. Eversion endarterectomy of the internal carotid artery: technique and results in 449 procedures. Surgery. 1996;
120(4):635-639.
De Syo D et al. Development of carotid endarterectomy at the sestre milosrdnice university hospital, zagreb (1970-1998) - what do we have
to do now. Acta Clin Croat. 1998; 37(2):48-58.
Deriu G and De Francesco T. Rationale for using a patch graft in carotid endarterectomy. [Razionale dell'uso del patch
nell'endoarteriectomia carotidea.]. Ann Ital Chir. 1997; 68(4):473-477.
Ecker RD et al. Durability of carotid endarterectomy. Stroke. 2003; 34:2941-2944.
Economopoulos KJ et al. Comparison of carotid endarterectomy using primary closure, patch closure, and eversion techniques. Am J Surg.
1999; 178:505-510.
Results
Candidate studies
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
Entz L et al. Late results after eversion endarterectomy of the internal carotid artery. Magy Seb. 2001; 54:5-9.
Fearn SJ and McCollum CN. Shortening and reimplantation for tortuous internal carotid arteries. J Vasc Surg. 1998; 27:936-939.
Friedman SG. Clinical application of eversion carotid endarterectomy. Vasc Endovascular Surg. 2003; 37:239-244.
Garofalo M et al. Neurological complications in carotid endarterectomy. Minerva Cardioangiol. 1999; 47:121-126.
Gelabert HA et al. Carotid endarterectomy with primary closure does not adversely affect the rate of recurrent stenosis. Arch Surg. 1994;
129:648-654.
Goldman KA et al. A comparative study of saphenous vein, internal jugular vein, and knitted dacron patches for carotid artery
endarterectomy. Ann Vasc Surg. 1995; 9:71-79.
Golledge J et al. Outcome of selective patching following carotid endarterectomy. Eur J Vasc Endovasc Surg. 1996; 11:458-463.
Green RM et al. Eversion endarterectomy of the carotid artery: Technical considerations and recurrent stenoses. J Vasc Surg. 2000;
32:1052-1061.
Green RM et al. The clinical course of residual carotid arterial disease. J Vasc Surg. 1991; 13:112-120.
Grego F et al. Is carotid endarterectomy in octogenarians more dangerous than in younger patients? J Cardiovasc Surg. 2005; 46(5):477483.
Hagmuller GW et al. Operative management of carotid artery stenosis. Z Kardiol. 2004; 11:206-211
Hertzer NR and Mascha EJ. A personal experience with coronary artery bypass grafting, carotid patching, and other factors influencing the
outcome of carotid endarterectomy. J Vasc Surg. 2006; 43(5):959-968.
Hertzer NR et al. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience
from 1989 to 1995. J Vasc Surg. 1997; 26(1):1-10.
Hertzer NR. The hidden statistics of carotid patch angioplasty. J Vasc Surg. 1994; 19(3):555-556.
Results
Candidate studies
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
Hugl B et al. Effect of age and gender on restenosis after carotid endarterectomy. Ann Vasc Surg. 2006; 20(5):602-608.
Iseli TA et al. Eversion carotid endarterectomy. ANZ J Surg. 2001; 71(10):570-573.
Jacobowitz GR et al. Long-term follow-up of saphenous vein, internal jugular vein, and knitted Dacron patches for carotid artery
endarterectomy. Ann Vasc Surg. 2001; 15(3):281-287.
Janoušek L et al. Comparison of eversion and standard endarterectomy of internal carotid artery. [Srovnání everzní a klasické
endarterektomie a. carotis interna]. Cesk Slov Neurol Neurochir. 2003; 66(3):203-205.
Jausseran JM et al. Carotid endarterectomy by the eversion method. One year arteriographical results. [Endarteriectomie carotidienne par
eversion: Resultats radiologiques a un an]. J Mal Vasc. 1998; 23(1):7-12.
Jausseran JM et al. The advantages of perioperative arteriography in carotid surgery (POAC). Giornale Italiano di Chirurgia Vascolare.
1998; 5(2):90-95.
Johnson CA et al. Early recurrent carotid artery stenosis. Current Surgery. 1999; 56(7-8):420-422.
Johnson CA et al. The natural history of early recurrent carotid artery stenosis. Am J Surg. 1999; 177(5):433-436.
Jokinen JJ et al. Results and future of carotid endarterectomy in a medium-sized Finnish central hospital. Scand J Surg. 2006; 95(1):33-38.
Jones CE et al. Technical results from the eversion technique of carotid endarterectomy. Am Surg. 1996; 62(5):361-365.
Katras T et al. Durability of eversion carotid endarterectomy: comparison with primary closure and carotid patch angioplasty. J Vasc Surg.
2001; 34(3):453-458.
Katz SG and Kohl RD. Does the choice of material influence early morbidity in patients undergoing carotid patch angioplasty? Surgery.
1996; 119(3):297-301.
Kieny R et al. Evolution of carotid restenosis after endarterectomy. Cardiovasc Surg. 1994; 2(5):555-560.
Koskas F et al. Carotid eversion endarterectomy – short-term and long-term results. Ann Vasc Surg. 1995; 9:9-15.
Results
Candidate studies
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
Koskas F et al. Carotid eversion endarterectomy: short- and long-term results. Ann Vasc Surg. 1995; 9(1):9-15.
Kresowik TF et al. Improving the outcomes of carotid endarterectomy: results of a statewide quality improvement project. J Vasc Surg.
2000; 31(5):918-926.
Ladowski JS et al. Factors contributing to recurrent carotid disease following carotid endarterectomy. Am J Surg. 1997; 174(2):118-120.
LaMuraglia GM et al. Determinants of carotid endarterectomy anatomic durability: effects of serum lipids and lipid-lowering drugs. J Vasc
Surg. 2005; 41(5):762-768.
Littooy FN et al. Comparison of standard carotid endarterectomy with Dacron patch angioplasty versus eversion carotid endarterectomy
during a 4-year period. Am Surg. 2004; 70(2):181-185.
Liu CJ et al. Eversion carotid endarterectomy for carotid stenosis. Zhonghua Wai Ke Za Zhi. 2005; 43:409-411.
Marien BJ et al. Bovine pericardium vs dacron for patch angioplasty after carotid endarterectomy: a prospective randomized study. Arch
Surg. 2002; 137(7):785-788.
Markovic DM et al. Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy. J Cardiovasc Surg
(Torino). 2008; 49(5):619-25.
Mazzarolo G et al. Carotid surgery in patients over the age of 80 years: Own experience. Ric Sci 2 Ser Pt 2 Rend [B]. 2001; 22:75-79.
Mehta M et al. Eversion technique increases the risk for post-carotid endarterectomy hypertension. J Vasc Surg. 2001; 34(5):839-845.
Motyka M et al. Preventive eversion endarterectomy in patients with stenosis of the carotid artery imparing cerebral hemodynamics. Chir
Narzadow Ruchu Ortop Pol. 2003; 5:97-102.
Naylor R et al. Randomized trial of vein versus dacron patching during carotid endarterectomy: long-term results. J Vasc Surg. 2004;
39(5):985-993.
Results
Candidate studies
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
Naylor R et al. Randomized trial of vein versus dacron patching during carotid endarterectomy: Long-term results. J Vasc Surg. 2004;
39(5):985-993.
Peiper C et al. Eversion endarterectomy versus open thromboendarterectomy and patch plasty for the treatment of internal carotid artery
stenosis. Eur J Vasc Endovas Surg. 1999; 18(4):339-343.
Perler BA et al. Carotid dacron patch angioplasty: Immediate and long-term results of a prospective series. Cardiovasc Surg. 1995;
3(6):631-636.
Pokrovskiǐ AV et al. Comparative analysis of carotid endarterectomy late outcomes related to intervention modality. Angiol Vasc Surg. 2005;
11(1):93-101.
Radak DJ et al. Temporal trends in eversion carotid endarterectomy for carotid atherosclerosis: Single-center experience with 5,034
patients. Vascular. 2007; 15(4):205-210.
Radak D et al. Single center experience on eversion versus standard carotid endarterectomy: A prospective non-randomized study.
Cardiovasc Surg. 2000; 8(6):422-428.
Raithel D and Schunn C. Eversion endarterectomy - out? Zentralblatt Fur Chirurgie. 2000; 125(3):239-242.
Reigner B et al. Eversion endarterectomy of the internal carotid artery: Midterm results of a new technique. Ann Vascr Surg. 1995; 9(3):241246.
Rockman CB et al. Primary closure of the carotid artery is associated with poorer outcomes during carotid endarterectomy. J Vasc Surg.
2005; 42(5):870-877.
Rosenthal D et al. Carotid patch angioplasty: immediate and long-term results. J Vasc Surg. 1990; 12(3):326-333.
Rush DS et al. The safety, efficacy, and durability of external carotid endarterectomy. J Vasc Surg. 1992; 16(3):407-413.
Schanzer et al. Restenosis after carotid endarterectomy performed with routine intraoperative duplex ultrasonography and arterial patch
closure: a contemporary series. Vasc Endovascular Surg. 2007; 41(3):200-205.
Results
Candidate studies
90.
91.
Schneider JR et al. Carotid endarterectomy in women versus men: patient characteristics and outcomes. J Vasc Surg. 1997; 25(5):890-898.
Seelig MH et al. Use of intraoperative duplex ultrasonography and routine patch angioplasty in patients undergoing carotid endarterectomy.
Mayo Clin Proc. 1999; 74(9):870-876.
92. Shah DM et al. Carotid endarterectomy by eversion technique. Adv Surg. 1999; 33:459-476.
93. Shah DM et al. Carotid endarterectomy by eversion technique: Its safety and durability. Ann Surg. 1998; 228(4):471-478.
94. Skelly CL et al. Routine early postoperative duplex scanning is unnecessary following uncomplicated carotid endarterectomy. Vasc
Endovascular Surg. 2002; 36(2):115-122.
95. Szabo A et al. Long-term restenosis rate of eversion endarterectomy on the internal carotid artery. Eur J Vasc Endovasc Surg. 2004;
27(5):537-539.
96. Szabó A et al. Early rise in serum VEGF and PDGF levels predisposes patients with a normal MBL2 genotype to restenosis after eversion
endarterectomy. Stroke. 2007; 38(8):2247-2253.
97. Thompson JM et al. Hemodynamics and anatomy after carotid endarterectomy: A comparison between two different surgical approaches. J
Vasc Technol. 1998; 22(2):89-94.
98. Verhoeven BAet al. Closure of the arteriotomy after carotid endarterectomy: patch type is related to intraoperative microemboli and
restenosis rate. J Vasc Surg. 2005 Dec;42(6):1082-1088.
99. Winkler GA et al. Comparison of intraoperative completion flowmeter versus duplex ultrasonography and contrast arteriography for carotid
endarterectomy. Vasc Endovascular Surg. 2006; 40(6):482-486.
100. Ziaja K et al. Treatment of critical stenosis of internal carotid artery in octogenarians. Chirurgia Polska. 2006; 8(1):27-32.
Future Work Plan
Project Schedule and Gantt Chart
Future Work Plan
Data Collection and Statistical Analysis
• descriptive data
number of patients subject to the procedure of interest
age of patient
presence of neurological symptoms
• methodologic data
randomized intervention
• outcome data
death
stroke
transient ischemic attack
degree of stenosis
Statistical
Analysis
References
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2.
3.
4.
5.
6.
7.
8.
9.
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the literature supporting use of these techniques? Semin Vasc Surg 2007; 20:226-235.
References
10. Cao P et al. A randomized study on eversion versus standard carotid endarterectomy: study design and
preliminary results: the Everest Trial. J Vasc Surg 1998; 27:595-605.
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12. Entz L et al. Comparison of perioperative results obtained with carotid eversion endarterectomy and with
conventional patch plasty. Cardiovasc Surg 1997; 5:16-20.
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17:243-252.
14. Aburahma AF et al. Prospective randomized trial of ACUSEAL (Gore-Tex) vs Finesse (Hemashield) patching
during carotid endarterectomy: Long-term outcome. J Vasc Surg 2008; 48:99-103.
15. Ballotta E et al. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and
reimplantation: a prospective randomized study. Surgery 1999; 125:271-279.
16. Crawford RS et al. Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg 2007;
46:41-48.
17. Cao P et al. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter
randomized trial. J Vasc Surg 2000; 31:19-30.