AORTIC-ARCH ANGIOGRAPHY PRIOR TO CAROTID ENDARTERECTOMY - IS ITS CONTINUED USE JUSTIFIED

Patients with significant stenosis at the carotid bifurcation are trad itionally subjected to four vessel aortic arch angiography prior to co nsideration for carotid endarterectomy. The advent of the non-invasive vascular laboratory has necessitated a reappraisal of this approach. Aims: 1. Determine the yield from aortic arch angiography and its infl uence on surgical management. 2. Evaluate the accuracy of clinical exa mination and the non-invasive vascular laboratory in the detection of aortic arch branch lesions. Methods: One hundred and twenty-nine conse cutive patients undergoing evaluation for carotid endarterectomy were prospectively enrolled into the study. The protocol entailed: 1. Clini cal recording of upper limb pulses, blood pressure and supraclavicular bruits. 2. Duplex scan examination to evaluate proximal inflow into t he carotid arteries. 3. Four vessel aortic arch angiography to detect aortic branch lesions. Data from the non-invasive tests were compared to angiography. Patients with aortic arch branch lesions were further evaluated to determine the proportion requiring additional surgery. Re sults: Nineteen patients had angiographic evidence of aortic branch di sease (14.7%); six involved the common carotid artery, three the innom inate artery and 10 the subclavian artery. All of these lesions were d etected by the combination of unequal blood pressure, pulse deficit, b ruit or duplex scan. Seven patients underwent additional surgery (5.4% ) which included carotid-subclavian bypass (five), aortoinnominate byp ass (one) and innominate endarterectomy (one).Conclusion: In patients with significant stenosis at the carotid bifurcation undergoing evalua tion for carotid endarterectomy, aortic arch angiography is unnecessar y except in a small percentage of patients with abnormal clinical and non-invasive findings.