Influence of eversion endarterectomy and patch reconstruction on postoperative blood pressure after carotid surgery.

Abstract

BACKGROUND\nPost carotid blood pressure fluctuation and hypertension (PEH) are associated with increased risk for adverse outcome; there is limited evidence on the impact of eversion endarterectomy (E-CEA) versus conventional endarterectomy with patch closure (C-CEA) on postoperative blood pressure course.\n\n\nPATIENTS AND METHODS\nIn this retrospective observational study, 859 consecutive carotid endarterectomy procedures between 2004 and 2014 (C-CEA n=585 vs. E-CEA n=274), were evaluated. Pre- and postoperative blood pressure values were recorded from recovery room until third postoperative day and compared between both techniques; influences on the dichotomous target variable at least one postoperative blood pressure peak , i.e. need for postoperative vasodilators, were analyzed by a logistic regression model. Influences on postoperative systolic blood pressure were evaluated by a linear mixed effects regression model.\n\n\nRESULTS\nPreoperative baseline blood pressure was not different between both comparison groups. During postoperative course, significantly increased mean systolic blood pressure values in the E-CEA group from recovery room to second postoperative day (recovery room C-CEA: 129.2 mmHg vs. E-CEA: 136.5 mmHg; p < 0.001; first postoperative day C-CEA: 132.4 mmHg vs. E-CEA: 139.3 mmHg; p\u202f=\u202f0.0002; second postoperative day C-CEA: 138.6 mmHg vs. E-CEA: 143.1 mmHg; p\u202f=\u202f0.023) were observed. No hyperperfusion syndrome was detected as wells as no difference in postoperative complication rate. Frequency of antihypertensive interventions was also elevated in E-CEA group (C-CEA 22.1 % vs. E-CEA 31.8 %; p\u202f=\u202f0.003). E-CEA (OR 1.591, 95% CI [1.146; 2.202];p=0.005) and presence of preoperatively elevated systolic readings (OR 1.015, 95%CI [1.006;1.024]; p<0.001) was also associated with increased need for antihypertensive interventions.\n\n\nCONCLUSION\nE-CEA was associated with significantly elevated postoperative blood pressure, compared to C-CEA. C-CEA was associated with postoperative blood pressure decrease; however, no difference as to neurologic and surgical complications was detected between both surgical techniques in clinical practice.