What happens to the external carotid artery following carotid endarterectomy?

AIMS: The effect of carotid endarterectomy on the patency of the external carotid artery is unknown. We conducted a retrospective study to evaluate the long-term changes in the external carotid artery following carotid endarterectomy. METHODS: Data was prospectively recorded for all patients who had carotid endarterectomy between 1997 and 2006 in our vascular surgical unit. These patients had follow-up with carotid duplex ultrasound to assess the patency of the internal and external carotid artery. The data were retrieved and evaluated for patency and flow characteristic in both arteries before and after surgery. RESULTS: Carotid endarterectomy was performed on 255 occasions in 236 patients over the ten year study period. Immediate and long-term outcome of carotid endarterectomy is comparable to results at other major centers. Stenosis of the external carotid artery as detected by duplex scan occurred in 5.5% of patients and was totally asymptomatic. CONCLUSION: Our results of carotid endarterectomy are comparable to other centers. Long-term follow up of the external carotid artery with duplex scan showed asymptomatic stenosis in a small percentage of patients.

Delayed rupture of common carotid artery following rugby tackle injury: a case report.

BACKGROUND: Common Carotid Artery (CCA) is an uncommon site of injury following a blunt trauma, its presentation with spontaneous delayed rupture is even more uncommon and a rugby tackle leading to CCA injury is a rare event. What makes this case unique and very rare is combination of all of the above. CASE PRESENTATION: Mr H. presented to the Emergency Department with an expanding neck haematoma and shortness of breath. He was promptly intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA. He underwent emergency surgery with repair of the defect and made an uneventful recovery post operatively. CONCLUSION: Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism. A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma is likely to be beneficial.

Endoluminal repair of abdominal aortic aneurysm: the Middlemore Hospital experience.

INTRODUCTION: With endoluminal stent graft (ESG) repair of abdominal aortic aneurysms (AAA) becoming more common, the morphological boundaries are constantly being pushed in deciding which patients to offer this mode of surgical management. In our tertiary hospital we have a relatively strict morphological selection as well as a multidisciplinary team that provides a good platform for performing endoluminal AAA repair. METHOD: A retrospective audit of patients undergoing elective endoluminal AAA repair at Middlemore Hospital (Otahuhu, Auckland, New Zealand) between 1999 and 2005 was performed; 40 patients were identified during this period and all records were reviewed. Prior to surgery, all patients had CT aortography with 3D-reconstruction, and each case was discussed at a multidisciplinary team meeting (vascular surgeons and interventional radiologists present). Patients less than 65 years of age were excluded from this endoluminal assessment. A strict morphological selection criteria was applied and adhered to. RESULTS: Forty patients underwent elective endoluminal AAA repair between 1999 and 2005--5:1 male:female ratio and mean age 73.4 years. Fifty percent of patients had a history of ischaemic heart disease, 48% had known hypertension, 33% had known pulmonary disease, 12% had known diabetes mellitus, while a previous stroke, chronic renal failure, and current smokers respectively accounted for 18%. The American Society of Anaesthesiology (ASA) classification was used to assess patient fitness for surgery. Eighty percent of patients in this study had an ASA of III, 15% had an ASA of II, and the remaining patients had an ASA of IV. These figures are similar to Australian audit data (audit undertaken by ASERNIP-S). Morphology AAA showed mean diameter AAA of 5.2 cm (4.3?6.7 cm). Most AAA were fusiform (fusiform 90% vs saccular 10%). All grafts were of Zenith Cook type bifurcated grafts. There were 2 endoleaks (5%)--type II endoleaks that were sealed with endovascular therapy; 2 patients returned to theatre for embolic complications with good postoperative result; and 1 patient died due to myocardial infarction (MI) postprocedure (mortality 2.5%). Primary technical success was 95% and secondary technical success 100%. There were no conversions to open surgery and no procedural-related deaths. CONCLUSION: This audit from Middlemore Hospital shows good results can be achieved using strict morphological selection criteria and a multidisciplinary approach to treatment for ESG of AAA.

Necrotizing fasciitis: analysis of 48 cases in South Auckland, New Zealand.

BACKGROUND: To assess the presentation, management and risk factors for mortality in necrotizing fasciitis at Middlemore Hospital in South Auckland, New Zealand. METHODS: A retrospective review of the medical records of patients presenting to Middlemore Hospital over a 6-year period (1997-2002) with a diagnosis of necrotizing fasciitis. RESULTS: Forty eight patients were identified. There were 27 men and 21 women whose age ranged from 19 to 80 years (median 51 years) at presentation. Maori and Pacific Islanders accounted for 64% of total admissions despite making up only 31% of the referral population. Streptococcus Pyogenes was the most common bacterial isolate (54%). 31% of patients had polymicrobial infections. Sixty-two per cent of cases involved extremities. The median number of operations and length of stay were 4 and 31 days, respectively. Overall mortality was 29%. In multivariate analysis, delay in surgical intervention (P = 0.015) and diabetes mellitus (P = 0.023) were found to be associated with increased mortality. Ethnicity, sex, type of pathogen, site of infection and increasing age did not affect mortality. CONCLUSION: Necrotizing fasciitis remains a significant problem in our community especially in the Maori and Pacific population. Early surgical debridement decreases mortality rates.