Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

  • Byeng Hun, Jeon (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Chul Ho, Lee (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Jae Seok, Jang (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Jun Woo, Cho (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine)
  • Received : 2022.06.24
  • Accepted : 2022.09.15
  • Published : 2022.12.05
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Abstract

Background: Carotid endarterectomy (CEA) is used to treat carotid stenosis, which is associated with cerebral infarction and may result in neurologic deficits such as stroke, transient ischemic attack (TIA), and local nerve injury. To decrease surgery-related complications and improve patient satisfaction with esthetic outcomes, efforts have been made to minimize incision size instead of using a standard longitudinal incision. Methods: We performed a retrospective analysis of 151 cases of CEA, of which 110 used conventional incisions and 41 used high mini-skin incisions (HMIs), from March 2015 to December 2021 at a single institution. Short-term (30-day) postoperative results were evaluated for rates of mortality, stroke, TIA, and cranial/cervical nerve injuries. Risk factors for nerve injury were also assessed. Results: The HMI group showed significantly (p<0.01) shorter operative and clamp times than the conventional group. The HMI group also had significantly shorter incision lengths (5.3±0.9 cm) than the conventional group (11.5±2.8 cm). The rates of stroke, TIA, and death at 30 days were not significantly different between the 2 groups. There was no significant difference in the rate of cranial and cervical nerve injuries, and all injuries were transient. A high lesion level (odds ratio [OR], 9.56; 95% confidence interval [CI], 3.21-28.42; p<0.01) and the clamp time (OR, 1.07; 95% CI, 1.03-1.12; p<0.01) were found to be risk factors for nerve injuries. Conclusion: Use of the HMI in CEA for carotid stenosis was advantageous for its shorter operative time, shorter internal carotid artery clamp time, reduced neurologic complications, and improved esthetics.

Keywords

Acknowledgement

This work was supported by a grant from the Research Institute of Medical Science, Catholic University of Daegu (2022).

References

  1. Marcus J, Knopman J, Stieg PE. Carotid endarterectomy. In: Winn HR, editor. Youmans and Winn neurological surgery. 7th ed. Philadelphia (PA): Elsevier; 2017. p. 3096-106. 
  2. de Donato G, Pasqui E, Panzano C, et al. Mini-skin incision for carotid endarterectomy: neurological morbidity and health-related quality of life. Ann Vasc Surg 2021;71:112-20. https://doi.org/10.1016/j.avsg.2020.07.034 
  3. Sinha S, Fok M, Goh A, Gadhvi VM. Outcomes after transverse-incision 'mini' carotid endarterectomy and patch-plasty. Vasc Specialist Int 2019;35:137-44. https://doi.org/10.5758/vsi.2019.35.3.137 
  4. North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJ, Taylor DW, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-53. https://doi.org/10.1056/NEJM199108153250701 
  5. Tanious A, Pothof AB, Boitano LT, et al. Timing of carotid endarterectomy after stroke: retrospective review of prospectively collected national database. Ann Surg 2018;268:449-56. https://doi.org/10.1097/SLA.0000000000002933 
  6. Ascher E, Hingorani A, Marks N, et al. Mini skin incision for carotid endarterectomy (CEA): a new and safe alternative to the standard approach. J Vasc Surg 2005;42:1089-93. https://doi.org/10.1016/j.jvs.2005.08.026 
  7. Farhat-Sabet A, Aicher BO, Tolaymat B, et al. An alternative approach to carotid endarterectomy in the high carotid bifurcation. Ann Vasc Surg 2020;65:240-6. https://doi.org/10.1016/j.avsg.2019.10.100 
  8. Kazimierczak A, Rybicka A, Rynio P, Gutowski P, Wiernicki I. Cosmetic effects of skin-crease camouflage incision versus longitudinal incision following carotid endarterectomy. Wideochir Inne Tech Maloinwazyjne 2018;13:102-10. https://doi.org/10.5114/wiitm.2018.72646 
  9. Deck M, Kopriva D. Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction. Can J Surg 2015;58:245-9. https://doi.org/10.1503/cjs.016714 
  10. Yuksel V, Ozdemir AC, Huseyin S, Guclu O, Turan FN, Canbaz S. Impact of surgeon experience during carotid endarterectomy operation and effects on perioperative outcomes. Braz J Cardiovasc Surg 2016;31:444-8. https://doi.org/10.5935/1678-9741.20160088 
  11. Bastounis E, Bakoyiannis C, Cagiannos C, et al. A short incision for carotid endarterectomy results in decreased morbidity. Eur J Vasc Endovasc Surg 2007;33:652-6. https://doi.org/10.1016/j.ejvs.2006.12.028 
  12. Zannetti S, Parente B, De Rango P, et al. Role of surgical techniques and operative findings in cranial and cervical nerve injuries during carotid endarterectomy. Eur J Vasc Endovasc Surg 1998;15:528-31. https://doi.org/10.1016/s1078-5884(98)80114-7 
  13. Assadian A, Senekowitsch C, Pfaffelmeyer N, Assadian O, Ptakovsky H, Hagmuller GW. Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision under regional anaesthesia. Eur J Vasc Endovasc Surg 2004;28:421-4. https://doi.org/10.1016/j.ejvs.2004.06.019 
  14. Uno M, Takai H, Yagi K, Matsubara S. Surgical technique for carotid endarterectomy: current methods and problems. Neurol Med Chir (Tokyo) 2020;60:419-28. https://doi.org/10.2176/nmc.ra.2020-0111 
  15. Marcucci G, Antonelli R, Gabrielli R, Accrocca F, Giordano AG, Siani A. Short longitudinal versus transverse skin incision for carotid endarterectomy: impact on cranial and cervical nerve injuries and esthetic outcome. J Cardiovasc Surg (Torino) 2011;52:145-52. 
  16. Ballotta E, Da Giau G, Renon L, et al. Cranial and cervical nerve injuries after carotid endarterectomy: a prospective study. Surgery 1999;125:85-91. https://doi.org/10.1016/s0039-6060(99)70292-8 
  17. Antoniou GA, Murray D, Antoniou SA, Kuhan G, Serracino-Inglott F. Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy. Ann R Coll Surg Engl 2014;96:184-9. https://doi.org/10.1308/003588414X13814021679357 
  18. Beasley WD, Gibbons CP. Cranial nerve injuries and the retrojugular approach in carotid endarterectomy. Ann R Coll Surg Engl 2008;90: 685-8. https://doi.org/10.1308/003588408X318138 
  19. Fokkema M, de Borst GJ, Nolan BW, et al. Clinical relevance of cranial nerve injury following carotid endarterectomy. Eur J Vasc Endovasc Surg 2014;47:2-7. https://doi.org/10.1016/j.ejvs.2013.09.022 
  20. Kakisis JD, Antonopoulos CN, Mantas G, Moulakakis KG, Sfyroeras G, Geroulakos G. Cranial nerve injury after carotid endarterectomy: incidence, risk factors, and time trends. Eur J Vasc Endovasc Surg 2017;53:320-35. https://doi.org/10.1016/j.ejvs.2016.12.026