Carotid endoarterectomy with normal findings from a completion study: Is there need for early duplex scan?

Objective: The objective of this study was to determine the value of early (< 6 months) duplex scanning after carotid endarterectomy (CEA) with an int raoperative completion study with normal results. Attention was paid to res tenosis rates and reoperation for recurrent stenosis within the first 6 mon ths. Methods: A retrospective review was performed on 380 CEAs (338 patients) wi th intraoperative completion studies and duplex surveillance within the fir st 6 months. Results of completion studies, restenosis rates, and recurrent symptoms wer e evaluated for each operation. Studies were performed from 0 to 200 days p ostoperatively (median, 28). Results: Intraoperative completion studies inc luded 333 angiograms, 26 duplex scans, and 21 angiograms with duplex scans. Of the 380 intraoperative completion studies, 28 (7.5%) had abnormal findi ngs, including 14 abnormal internal carotid arteries (ICAs). Twenty-four pr ocedures were revised, and the findings of all repeat completion studies we re normal. Of the initial completion studies, in four cases, abnormalities (3 ICAs) were insignificant and did not warrant further intervention. Follo w-up ICA duplex scans had normal results after 364 (95.8%) CEAs. There were 14 mild recurrent ICA stenoses and two moderate recurrent ICA stenoses; ne ither had abnormal findings from the completion study. There were no severe recurrent ICA stenoses. External carotid artery (ECA) recurrent stenosis i ncluded 7 mild, 15 moderate, and 9 severe restenoses. Conclusions: Only 0.5% of CEAs developed moderate restenosis. No procedures had severe recurrent stenosis on duplex scan within the first 6 months, an d none required intervention. Duplex surveillance in the first 6 months is relatively unproductive, providing that there were normal results from an i ntraoperative completion study for each patient. Routine surveillance can b e started at 1 year.