Prevention of postoperative wound haematomas and hyperperfusion following carotid endarterectomy

Objective: to study the incidence of wound haematomas and hyperperfusion fo llowing carotid endarterectomy and the effect of changes in perioperative m anagement. Methods: we undertook a prospective audit of the postoperative outcome of 3 00 consecutive carotid endarterectomies performed for a symptomatic stenosi s of the internal carotid artery, under the care of a single consultant. Results: audit of the first 100 operations between 1990-93 resulted in 4 ch anges to clinical practice. These included the use of Dacron instead of vei n because of 3 vein patch blowouts, invasive postoperative monitoring of bl ood pressure, and the use of intravenous beta-blockers to control hypertens ion, because of 4 hyperperfusion injuries. The use of 10F suction drains wa s discontinued, because they did not prevent 8 wound haematomas. The result s of the second 100 cases between 1994-97 and the third 100 cases between 1 998-2000 confirmed no further hyperperfusion injuries or patch blowouts (p = 0.01 and 0.04 respectively). Larger 14F suction drains were reintroduced for the third series because of thirteen blockers fell in the third series due to the introduction of local anaesthesia (p = 0.0001). Conclusion: the use of Dacron patches and postoperative control of hyperten sion has reduced the incidence of haemorrhage and hyperperfusion after caro tid endarterectomy. Larger suction drains may also help.