FOR HOW LONG SHOULD CAROTID ENDARTERECTOMY SURVEILLANCE BE CONTINUED

Early restenosis represent the most important and more common failure after carotid endarterectomy. For this reason, after its first descrip tion made in 1976 by Stoney and String, it raised general interest amo ng vascular surgeons. In spite of the efforts to clear the causes of t his phenomenon, none of the numerous papers published in the literatur e has defined a specific cause determining restenosis. Nevertheless, a t present, this hyperplastic response of the arterial wall to trauma a fter operation is generally considered benign because it is rarely res ponsible for new neurological symptoms or early internal carotid arter y occlusion. This unanimous conviction has been achieved after years o f instrumental and clinical postoperative follow-up performed all over the world. At the same time and probably for these reasons, recently, a new discussion has begun about the usefulness and cost-effectivenes s of prolonged Duplex scanning postoperative surveillance of the endar terectomized carotid arteries. This new question raised our curiosity in verifying the validity of this new approach, so we reviewed accurat ely our laboratory follow-up registry and the data regarding onset, ev olution and clinical outcome of early restenosis. These data associate d with a meticulous review of the experience of other authors convince d us that the patients operated on, need, in most cases, a short even aggressive period of careful follow-up (generally the first six months ). If during this period no irregularities or new stenosis is detected at the site of the endarterectomy, we, in agreement with others, beli eve that it is justified that the patients can be withdrawn from a pro longed instrumental follow-up, permitting laboratory working time to b e redirected towards the diagnosis of new vascular diseases.