Editor-in-Chief Ufuk Demirkılıç Frequency Quarterly Abbreviation Turk J Vasc Surg Publisher Turkish National Vascular and Endovascular Surgery Society ISSN 2667-4947 E-ISSN 2667-5080

Turkish Journal of Vascular Surgery 2020 , Vol 29 , Issue 2
Carotid endarterectomy under local anesthesia: An institutional report of experience
Atilla Saraç1, Artan Jahollari2
1Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey
2Department of Cardiovascular Surgery, American Hospital 3, Tirane, Albania
DOI : 10.9739/tjvs.2020.632 Objectives: This study aims to present our personal single-surgeon experience regarding carotid endarterectomy (CEA) procedures performed under local anesthesia.

Patients and methods: Between January 2007 and December 2012, a total of 215 CEA procedures in 203 patients (164 males, 39 females; mean age 66.5±7.9 years; range, 43 to 85 years) were retrospectively analyzed. Local anesthesia was achieved with single bolus injection of 10 mL of 2% prilocaine. An awake test was performed for three min following arterial clamping. Arteriotomy line was closed primarily in a continuous fashion. An intraluminal shunt was used in patients who developed neurological symptoms during the awake clamp testing.

Results: Twelve patients (5.9%) underwent staged CEA for bilateral disease and 88 patients (43.3%) underwent coronary artery bypass grafting following the initial CEA. None of procedures converted to general anesthesia. Transient ischemic attack developed in five patients (2.4%), cerebral infarction in five patients (2.4%), myocardial infarction in two patients (0.98%), and a neck hematoma in six patients (2.9%). Revision for neck hematoma within the first 24 hours was required in two patients (0.98%). The mean follow-up was 40.1±6.6 months. Two patients (0.98%) had significant restenosis within two years and one of them underwent repeated CEA. There were five late mortalities (2.4%). The patency rate was 99% during follow-up.

Conclusion: Low complication rates and excellent patency rates can be achieved using local anesthesia during CEA for isolated unilateral carotid stenosis. This technique also allows implementation of a staged procedure early after the operation. Keywords : Carotid endarterectomy, carotid stenosis, local anesthesia