Outcome elaluation of eversion endarterectomy of carotid artery by modified incision method - clinical study and computed model

UVOD: Everzivna endarterektomija karotidne arterije operacijski je zahvat kojim se bolesniku s hemodinamski značajnim suženjem smanjuje rizik nastanka moždanog udara. Modifikacijom oblika reza operacijski zahvat postaje jednostavniji i na osnovu iskustava kirurga s Odjela za vaskularnu kirurgiju, Klinike za kirurgiju Kliničkog bolničkog centra Osijek, pokazuje dobre poslijeoperacijske rezultate. CILJEVI ISTRAŽIVANJA: Cilj je kliničkog istraživanja utvrditi incidenciju komplikacija primjene modificirane kirurške tehnike te incidenciju hemodinamski značajnih restenoza. Dobiveni rezultati uspoređeni su s rezultatima standardne tehnike iz relevantne svjetske literature. Klinička studija nadopunjena je računalnim modelom koji pokazuje poslijeoperacijske hemodinamske uvjete na mjestu endarterektomije, prigodom modificirane i standardne operacijske tehnike u idealnim uvjetima, bez restenoze na šavnoj liniji i u uvjetima razvijene restenoze različitog stupnja. REZULTATI: Klinička je studija pokazala da nema statistički značajne razlike između incidencije komplikacija u našoj studiji, u kojoj je korištena modificirana operacijska tehnika, i incidencije komplikacija objavljene u svjetski relevantnim istraživanjima, gdje je korištena standardna tehnika. Broj restenoza u našoj studiji je značajno manji, no ovaj se podatak mora uzeti s rezervom, jer je naš uzorak manji od uzorka u velikim svjetskim studijama. Računalni model, koji uspoređuje hemodinamske parametre na mjestu endarterektomije prigodom standardne i modificirane tehnike u uvjetima razvoja restenoze, pokazuje znatno bolje rezultate pri upotrebi modificirane operacijske tehnike. ZAKLJUČAK: Modificirana everzivna endarterektomija karotidne arterije je zahvat koji se može primijeniti za gotovo sve bolesnike s hemodinamski značajnom stenozom karotidne arterije. Ova je tehnika jednostavnija za izvođenje od standardne procedure. Klinička je studija pokazala da modificirana everzivna endarterektomija ima jednak broj komplikacija kao i standardna tehnika, a vjerojatno ima manji broj restenoza. Klinička studija i računalni model pokazuju nam da everzivna endarterektomija karotidne arterije s modificiranim oblikom incizije ima svoje mjesto u svakodnevnoj praksi, zbog očigledne dobrobiti za bolesnike. Kako bi se definitivno potvrdile prednosti ove operacijske modifikacije, potrebno je provesti daljnja istraživanja.INTRODUCTION: Eversion endarterectomy of carotid artery is a surgical procedure that lowers the incidence of stroke in patients with hemodinamically significant stenosis of carotid artery bifurcation. By modification of the shape of incision, surgical procedure becomes easier to perform and based on current experience of vascular surgeons from Department of Vascular Surgery, Clinic for Surgery, Clinical Hospital Centre Osijek, it gives good postoperative results. AIM: The major goal of this study was to determine the incidence of complications when applying modified surgical technique and the incidence of hemodinamically significant restenoses. Gathered data was compared to the results from the relevant world literature when standard surgical technique was performed. Clinical study was supplemented and supported by a computer model that is showing postoperative hemodinamical conditions at the site of endarterectomy with modified and standard surgical technique, in ideal conditions with no restenosis at the site of suture line and in conditions of different grades of restenoses. RESULTS: The study showed that there was no statistically significant difference in the incidence of complications between our study where modified surgical technique was used and the data from the studies in which standard surgical technique was performed. The number of restenoses in our study was significantly lower. Computer model that is comparing hemodinamical parameters at the site of endarterectomy with standard and modified surgical procedure and the development of restenosis, showed significantly better results with modified surgical technique. CONCLUSION: Eversion endarterectomy with modified shape of incision could be performed in almost all patients with carotid artery stenosis as it is technically easier to perform than a standard technique. Clinical study showed that modified surgical technique has the same incidence of complications as standard technique and probably smaller incidence of restenoses. This clinical and computer based research showed that modified eversion technique has a place 60 in everyday practice because of the benefit for the patients. To establish definite advantages of this technique, further studies need to be conducted. KEY WORDS: carotid endarterectomy, modified eversion technique, clinical trail, hemodinamic model, restenosis 6