The perioperative outcomes of eversion carotid endarterectomy in diabetic patients aged 80 years or older

Background Uncertainty exists about the influence of advanced age and diabetes mellitus on the clinical effect of carotid endarterectomy (CEA). This study analyzed the perioperative (30-day) outcomes of CEA in diabetic patients aged ≥80 years. Methods Data of 1872 consecutive patients who underwent...

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Bibliographic Details
Published in:Journal of vascular surgery 2016-08, Vol.64 (2), p.348-353
Main Authors: Ballotta, Enzo, MD, Toniato, Antonio, MD, Farina, Filippo, MD, Baracchini, Claudio, MD
Format: Article
Language:English
Subjects:
Age Factors
Aged, 80 and over
Anesthesia, General
Carotid Stenosis - complications
Carotid Stenosis - diagnostic imaging
Carotid Stenosis - surgery
Comorbidity
Diabetes Complications - etiology
Diabetes Complications - prevention & control
Diabetes Mellitus - diagnosis
Diabetes Mellitus - therapy
Electroencephalography
Endarterectomy, Carotid - adverse effects
Female
Heart Diseases - complications
Humans
Intraoperative Neurophysiological Monitoring - methods
Male
Registries
Risk Factors
Severity of Illness Index
Stroke - etiology
Stroke - prevention & control
Surgery
Time Factors
Treatment Outcome
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Summary:Background Uncertainty exists about the influence of advanced age and diabetes mellitus on the clinical effect of carotid endarterectomy (CEA). This study analyzed the perioperative (30-day) outcomes of CEA in diabetic patients aged ≥80 years. Methods Data of 1872 consecutive patients who underwent 2125 primary eversion CEAs from 1990 to 2014 at our institution were prospectively stored in a vascular surgery registry. Risk factors, medication, and indication for surgery were recorded. The 354 patients (387 CEAs) aged ≥80 years formed the study base; of whom, 207 (219 CEAs) were diabetic and 147 (168 CEAs) were not. A neurologist assessed all patients preoperatively, on waking from the anesthesia, and before discharge from the hospital. All procedures were eversion CEA performed by the same surgeon under general anesthesia with routine electroencephalographic monitoring for selective shunting. Results Diabetic patients were more likely to have arterial hypertension ( P  = .033), cardiac disease ( P  = .038), peripheral aneurysmal/atherosclerotic disease ( P  = .046), and contralateral carotid occlusion ( P  = .042) than their nondiabetic counterparts. Overall, there were no deaths, two (0.51%) perioperative strokes (both in diabetic patients), and 13 nonfatal cardiac complications (3.3%), of which 10 occurred in diabetic patients, but the difference failed to reach statistical significance. Conclusions Findings from this study show that CEA is safe and effective for stroke prevention in diabetic patients aged ≥80 years, with a negligible incidence of perioperative adverse events and no deaths.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2016.01.052