Preoperative duplex on admission prevents unnecessary carotid surgery.
Devalia K., Riches J., Hands L., Handa A.
OBJECTIVES: Our unit policy is to duplex on admission all patients undergoing carotid endarterectomy to confirm patency. The aim of this study was to evaluate whether this had led to avoidance of unnecessary carotid surgery in a significant number of patients. METHODS: Over a 7-year period from January 1997 to December 2003, a total of 475 patients were scheduled for carotid endarterectomy. Of these, 439 patients subsequently underwent carotid endarterectomy. These data were obtained from prospectively collected vascular departmental records and we also hand searched notes of the 36 cancelled patients. RESULTS: There were a total of 36 cancellations for various reasons. Of these, 8 were clearly occluded on duplex. A further 16 were highly suspicious of occlusion on duplex and thus surgery was deferred and selective angiography was undertaken. Of these 9 were confirmed to be occluded on angiogram and a further 4 had severe stenoses or virtual occlusion, 3 patients had a distal internal carotid artery occlusion. Thus a total of 24 patients had an occlusion either diagnosed directly on duplex or because of suspicion on duplex. Unnecessary carotid surgery was avoided in 24 of 475 (5%) of patients. CONCLUSION: This study shows that a preoperative duplex on admission for surgery results in 1 of 20 patients avoiding unnecessary carotid surgery.