Value of intraoperative duplex imaging during supervised carotid endarterectomy

Background: For overall benefit, carotid endarterectomy requires low periop erative morbidity and mortality rates. Carotid thrombosis is usually second ary to technical error, which may be related to the experience of the opera tor. In this retrospective study the clinical and technical outcome of caro tid endarterectomies performed by one consultant and five trainees were com pared. Methods: Some 149 patients underwent carotid endarterectomy; 89 were operat ed on by the consultant and 60 by trainees. Intraoperative duplex imaging o f the carotid repair was performed before wound closure, and re-exploration was carried out when there was a residual severe stenosis associated with an intimal flap. Results: There was no significant difference in clinical outcome between op erations done by consultant or trainees. There was a significant increase i n the number of stenoses, kinks and flaps in carotid endarterectomies perfo rmed by trainees compared with those of the consultant both before (chi (2) = 12.0, 1 d.f., P < 0.001) and after (<chi>(2) = 10.1, 1 d.f., P < 0.001) correction. Conclusion: Intraoperative duplex imaging may facilitate training by provid ing an objective assessment of the quality of the operation.