PREOPERATIVE TESTING BEFORE CAROTID ENDARTERECTOMY - A SURVEY OF VASCULAR SURGEONS ATTITUDES

Traditional surgical practice and published consensus statements from major vascular surgery specialty societies have considered contrast ar teriography to be a routine part of the diagnostic evaluation prior to carotid endarterectomy (CEA), However, some surgeons now omit routine preoperative arteriography if a technically adequate carotid duplex s can is performed and indications for CEA are clear. To better establis h current practice patterns and to characterize vascular surgeons' opi nions about the role of preoperative arteriography, the Peripheral Vas cular Surgery Society membership was surveyed by mail. Eighty-six perc ent of the members responded (430 of 502). Ninety-three percent of all patients considered for CEA are evaluated with duplex scanning; 82% w ith arteriography, While the majority of surgeons typically obtain bot h a duplex scan and an arteriogram, 70% have performed CEA without a p reoperative arteriogram. Brain imaging studies (CT or MRI) are obtaine d in 26% and MR angiograms in 10% of cases. Seventy-five percent of th e surgeons agreed with the statement that CEA without preoperative art eriography is an acceptable practice if appropriate indications for su rgery are present. Furthermore, one third believed that CEA without a preoperative arteriogram is generally acceptable (acceptable more than half the time). Respondents were stratified by surgical experience ti me in practice and practice type. No significant differences in respon ses were found, suggesting the acceptance of CEA without preoperative arteriography is broad-based. This survey demonstrates changing attitu des among practicing vascular surgeons regarding the necessity for rou tine arteriography prior to CEA. Carotid endarterectomy on the basis o f duplex scanning and clinical assessment should be considered an acce pted alternative.