Carotid endarterectomy results in the early years of practice

Abstract

Background: Newly qualified surgeons, as well as their referring physicians, are understandably anxious when dangerous surgery is contemplated. Carotid endarterectomy (CEA), which requires a low morbidity/mortality rate to be successful, is especially problematic in this realm. There is a paucity of literature indicating the results that can be expected when a less-experienced surgeon is asked to perform this procedure. As the volume of CEA surgery is expected to decrease in the future with improvements in endovascular techniques, there will be fewer highly experienced CEA surgeons around.

Methods: We studied the first consecutive, prospectively recorded 100 CEAs performed by each of two newly qualified surgeons (200 total) between January 1993 and May 1998. Standard technique was used and all cases were done under general anesthesia. The only difference in technique was the more liberal use of shunting and protamine by one individual.

Results: There were no significant differences in the patient demographics between the two surgeons. Seventy-five percent of the cases harbored symptomatic stenoses. An overall combined stroke/mortality rate of 5.5% was observed. The rate in those operated on for symptomatic stenosis (n = 150) was 6% while it was 4% for those with asymptomatic pathology. There were no significant differences in outcome between the two surgeons. The average stroke/mortality rate in the first 50 cases for each surgeon was 7%, as opposed to 4% for the second 50 cases.

Conclusions: These data indicate that less-experienced individuals can perform this procedure with good results.