High-dependency unit care after carotid endarterectomy for asymptomatic stenosis
INTRODUCTION: Asymptomatic patients benefit from 3 to 6 hours of neurological and invasive blood pressure (BP) monitoring following carotid endarterectomy (CEA). Only a minority of patients will benefit from a prolonged stay in a high-dependency unit (HDU). The aim of this study was to externally v...
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| Language: | Portuguese |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2025-01-01
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| Series: | Angiologia e Cirurgia Vascular |
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| Online Access: | https://acvjournal.com/index.php/acv/article/view/616 |
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| author | Beatriz Guimarães Andreia Coelho Marina Dias-Neto Ricardo Castro-Ferreira João Peixoto Luís Fernandes Roberto Boal Marta Machado Francisco Basílio Patrícia Carvalho Armando Mansilha Alexandra Canedo |
| author_facet | Beatriz Guimarães Andreia Coelho Marina Dias-Neto Ricardo Castro-Ferreira João Peixoto Luís Fernandes Roberto Boal Marta Machado Francisco Basílio Patrícia Carvalho Armando Mansilha Alexandra Canedo |
| author_sort | Beatriz Guimarães |
| collection | DOAJ |
| description |
INTRODUCTION: Asymptomatic patients benefit from 3 to 6 hours of neurological and invasive blood pressure (BP) monitoring following carotid endarterectomy (CEA). Only a minority of patients will benefit from a prolonged stay in a high-dependency unit (HDU). The aim of this study was to externally validate previously described predictive variables of postoperative need for prolonged HDU stay.
METHODS: To identify patients needing HDU stay, a composite outcome (CO) was created, including cardiac events, neurologic deterioration, postoperative aminergic/ventilatory support, and prolonged use of intravenous (IV) BP control therapy. A retrospective study was performed in one center: increased clamping time, preoperative systolic BP, systolic BP during pre-anesthetic procedure, maximum intraoperative mean arterial pressure (MAP), and eversion technique were significant predictors for the CO. We aimed to ascertain the validity of these factors in an independent population. Consecutive patients submitted to asymptomatic CEA in the same period were retrospectively analyzed in a second independent center.
RESULTS: A total of 51 procedures were included (86.3% male; 69.2±7.9 years) and 11 (21.6%) presented with the CO. The presence of diabetes was associated with a higher incidence of the CO (p=0.011), and acetaminophen as intraoperative analgesia demonstrated an inverse correlation with the CO (p<0.001). Receiver operator characteristic curve analysis of predictive factors revealed that intraoperative maximum MAP had a strong correlation with the CO (area under the curve – AUC – 0.739, p=0.017). The remaining variables also did not reach statistical significance.
CONCLUSIONS: In this analysis, the risk for CO development was consistently increased in patients who developed high MAP intra-operatively, highlighting the need for scrupulous BP management to reduce potential complications.
However, we identified two previously unidentified associations: first, diabetics were more prone to develop complications and were more likely to benefit from HDU stay. Second, acetaminophen as intraoperative analgesia could have a protective role against CO development.
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| format | Article |
| id | doaj-art-b82dd949013e48a08d108490db072e59 |
| institution | Kabale University |
| issn | 1646-706X 2183-0096 |
| language | Portuguese |
| publishDate | 2025-01-01 |
| publisher | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| record_format | Article |
| series | Angiologia e Cirurgia Vascular |
| spelling | doaj-art-b82dd949013e48a08d108490db072e592025-01-29T23:21:00ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962025-01-0120310.48750/acv.616High-dependency unit care after carotid endarterectomy for asymptomatic stenosisBeatriz Guimarães0Andreia Coelho1Marina Dias-Neto2Ricardo Castro-Ferreira3João Peixoto4Luís Fernandes5Roberto Boal6Marta Machado7Francisco Basílio8Patrícia Carvalho9Armando Mansilha10Alexandra Canedo11Department of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, Portugal; Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine of University of Porto, Porto, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, Portugal; Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine of University of Porto, Porto, PortugalDepartment of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine of University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, São João Local Health Unit, Porto, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, PortugalDepartment of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine of University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, São João Local Health Unit, Porto, PortugalDepartment of Angiology and Vascular Surgery, Gaia Espinho Local Health Unit, Vila Nova de Gaia, Portugal INTRODUCTION: Asymptomatic patients benefit from 3 to 6 hours of neurological and invasive blood pressure (BP) monitoring following carotid endarterectomy (CEA). Only a minority of patients will benefit from a prolonged stay in a high-dependency unit (HDU). The aim of this study was to externally validate previously described predictive variables of postoperative need for prolonged HDU stay. METHODS: To identify patients needing HDU stay, a composite outcome (CO) was created, including cardiac events, neurologic deterioration, postoperative aminergic/ventilatory support, and prolonged use of intravenous (IV) BP control therapy. A retrospective study was performed in one center: increased clamping time, preoperative systolic BP, systolic BP during pre-anesthetic procedure, maximum intraoperative mean arterial pressure (MAP), and eversion technique were significant predictors for the CO. We aimed to ascertain the validity of these factors in an independent population. Consecutive patients submitted to asymptomatic CEA in the same period were retrospectively analyzed in a second independent center. RESULTS: A total of 51 procedures were included (86.3% male; 69.2±7.9 years) and 11 (21.6%) presented with the CO. The presence of diabetes was associated with a higher incidence of the CO (p=0.011), and acetaminophen as intraoperative analgesia demonstrated an inverse correlation with the CO (p<0.001). Receiver operator characteristic curve analysis of predictive factors revealed that intraoperative maximum MAP had a strong correlation with the CO (area under the curve – AUC – 0.739, p=0.017). The remaining variables also did not reach statistical significance. CONCLUSIONS: In this analysis, the risk for CO development was consistently increased in patients who developed high MAP intra-operatively, highlighting the need for scrupulous BP management to reduce potential complications. However, we identified two previously unidentified associations: first, diabetics were more prone to develop complications and were more likely to benefit from HDU stay. Second, acetaminophen as intraoperative analgesia could have a protective role against CO development. https://acvjournal.com/index.php/acv/article/view/616carotid endarterectomyasymptomatic carotid diseasecomplicationshigh-dependency unit |
| spellingShingle | Beatriz Guimarães Andreia Coelho Marina Dias-Neto Ricardo Castro-Ferreira João Peixoto Luís Fernandes Roberto Boal Marta Machado Francisco Basílio Patrícia Carvalho Armando Mansilha Alexandra Canedo High-dependency unit care after carotid endarterectomy for asymptomatic stenosis Angiologia e Cirurgia Vascular carotid endarterectomy asymptomatic carotid disease complications high-dependency unit |
| title | High-dependency unit care after carotid endarterectomy for asymptomatic stenosis |
| title_full | High-dependency unit care after carotid endarterectomy for asymptomatic stenosis |
| title_fullStr | High-dependency unit care after carotid endarterectomy for asymptomatic stenosis |
| title_full_unstemmed | High-dependency unit care after carotid endarterectomy for asymptomatic stenosis |
| title_short | High-dependency unit care after carotid endarterectomy for asymptomatic stenosis |
| title_sort | high dependency unit care after carotid endarterectomy for asymptomatic stenosis |
| topic | carotid endarterectomy asymptomatic carotid disease complications high-dependency unit |
| url | https://acvjournal.com/index.php/acv/article/view/616 |
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