THE PRACTICE OF CAROTID ENDARTERECTOMY IN AUSTRALASIA

Background: Carotid endarterectomy (CEA) is a frequently performed sur gical procedure and there are variations in the preoperative, operativ e and postoperative management related to this operation. Methods: Que stionnaires were sent to all 191 members of the Division of Vascular S urgery, Royal Australasian College of Surgeons, and the Australasian C hapter of the International Society of Cardiovascular Surgery. Results : The questionnaire was returned by 179 surgeons (94%). One hundred an d fifty-nine were vascular surgeons, of whom 139 perform CEA. Most sur geons reported performing more CEA than 5 years previously. Surgery fo r asymptomatic carotid stenosis was performed by 78% of surgeons at th e time of the survey. Routine carotid angiography is performed pre-ope ratively for symptomatic patients by 61% of surgeons and for asymptoma tic patients by 56%. Intra-operative shunting is used routinely by 37% of surgeons, selectively by 58% and never by 5%. Arteriotomy patch cl osure is performed routinely by 16%, usually by 30%, rarely by 52% and never by 3%. The favoured patch material is Dacron 39%, PTFE 19%, ank le long saphenous vein (LSV) 22%, thigh LSV 18% or other materials 2%. Compared to their practice 5 years previously, arterial patch closure is used more often by 42% of surgeons, the same by 51% and less by 7% . Postoperatively, patients are nursed mainly in intensive care (34%) or a high-dependency unit (33%). Conclusions: The practice of CEA by A ustralasian vascular surgeons reflects the recent trends reported in t he world literature. Most Australasian surgeons perform CEA for asympt omatic disease. Forty per cent are performing CEA on the basis of dupl ex scanning alone. There is a trend towards increased use of patch clo sure. Most patients are managed in intensive care or high-dependency u nits.