ABSTRACT
OBJECTIVE: Surgery for extracranial carotid artery disease has been challenged by carotid angioplasty stenting because the latter is less invasive and avoids surgical trauma. In fact, the magnitude of the perioperative stress response evoked by carotid endarterectomy (CEA) has never been evaluated. Our aim was to determine the degree of surgical trauma caused by CEA and to define differences related to the use of locoregional or general anesthesia. METHODS: We prospectively studied 113 consecutive CEAs performed on 109 patients admitted at a community institutional center. Patients were stratified for demographics and risk factors and operated on under locoregional (LA) or general anesthesia (GA) depending on both the surgeon preference and patient's compliance. Selective carotid shunting was performed for patients who manifested neurologic deficits under LA or had stump pressure values 120 minutes. Three patients experienced an intraoperative neurologic event and had higher post-CACC cortisol values as compared to asymptomatic patients. CONCLUSIONS: Intraoperative surgical stress was higher under LA and was blunted by carotid shunting under both LA and GA. Within 2 hours after surgery the anesthetic modality no longer had any impact on surgical trauma. The stress response to CEA, regardless of the type of anesthesia, was abolished within 24 hours. Intraoperative stress response, namely hypercortisolemia, directly correlated with subclinical and clinical cerebral hypoperfusion/ischemia during CACC. Hence, attenuation of the stress response to CEA might decrease the incidence of cerebral ischemic events.
Subject(s)
Endarterectomy, Carotid , Perioperative Care , Stress, Psychological/drug therapy , Adrenocorticotropic Hormone/metabolism , Aged , Aged, 80 and over , Anesthesia, General , Anesthesia, Local , Biomarkers/blood , C-Reactive Protein/metabolism , Carotid Artery Diseases/epidemiology , Carotid Artery Diseases/surgery , Carotid Artery, Internal/surgery , Combined Modality Therapy , Female , Humans , Hydrocortisone/metabolism , Italy/epidemiology , Male , Postoperative Complications/etiology , Postoperative Complications/mortality , Prolactin/metabolism , Prospective Studies , Risk Factors , Sex Factors , Statistics as Topic , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Surgical Instruments , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: Polidocanol sclerotherapy is a well-established therapeutic modality for the treatment of venous malformations. Systemic complications are extremely rare. OBJECTIVE: To report a case of cardiac complication after polidocanol injection of peripheral venous malformation. METHODS: A case report and a review of the English language literature using a published MEDLINE search strategy. RESULTS: A patient undergoing polidocanol sclerotherapy for a symptomatic venous malformation of the right inferior limb developed cardiac arrest shortly after injection of the sclerosing agent which was promptly reversed. CONCLUSION: Systemic complications following sclerotherapy may occur even when the sclerosant is injected in peripheral veins or venous malformations. Clinicians should be alerted to the possibility of uncommon but life-threatening adverse effects.
