Haematomas after carotid endarterectomy can be reduced by direct pressure to the neck postoperatively

Abstract

Introduction A recognised complication of carotid endarterectomy (CEA) is postoperative haematoma, which can threaten the airway. Previous studies have looked at medical methods of preventing this complication. This study aims to evaluate the impact of simple direct pressure postoperatively on the development of haematoma. Materials and methods From 2011 to 2016, 161 consecutive CEA were performed by a single surgeon or trainee under supervision. After 80 operations, the postoperative technique was altered, with additional pressure being applied by the surgeon to the skin incision from completion of suturing until each patient was awake in the recovery room. The rates of postoperative haematoma and other complications were compared between the pre- and post-intervention groups, as well as grade of surgeon, urgency of operation and antiplatelet/anticoagulant use. Results Post-carotid haematomas were eliminated in the post-intervention group (0/81); in the pre-intervention group 7/80 patients developed haematoma (P < 0.05). There were no significant differences in urgency of surgery, antiplatelet/anticoagulant use, grade of surgeon or other complications (stroke: 2/80 vs 0/81 P < 0.05), suggesting that this was not a learning curve effect. Discussion The results suggest that applying direct pressure helps to reduce oozing, provides time to monitor and identify additional bleeding and protects the wound from excessive strain that may be caused by coughing while the patient wakes up. We advise that the lead surgeon should apply such pressure to ensure precise and focal targeting, for maximum effect. Conclusion During recovery from CEA, focused and prolonged pressure by the operating surgeon is a highly effective method of reducing haematoma.

Keywords: Carotid endarterectomy; Direct pressure; Haematoma.

Figure 1

Incidence of haematomas before and after changes in surgical technique (P = 0.0065)

Figure 2

Incidence of other complications, cranial nerve injury, transient ischaemic attack (TIA), stroke and hoarseness of voice before and after change in surgical technique, (P = 0.7196, P = 0.3672, P = 0.4969 and P = 0.6203, respectively)

Figure 3

Frequency of patients developing haematomas with consultant-led and consultant supervised carotid endarterectomy (CEA) (P = 0.3479)

Figure 4

Incidence rate of haematoma formation in rapid-access (RACE) and elective (ECE) carotid endarterectomy procedures (P = 1.000)