Dl. Dawson et al., PREOPERATIVE TESTING BEFORE CAROTID ENDARTERECTOMY - A SURVEY OF VASCULAR SURGEONS ATTITUDES, Annals of vascular surgery, 11(3), 1997, pp. 264-272
Citations number
54
Categorie Soggetti
Peripheal Vascular Diseas","Cardiac & Cardiovascular System
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.