Eversion Carotid Endarterectomy: A Safe, Advantageous Alternative to Conventional Carotid Endarterectomy

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Abstract
Objective: To compare the results and time and cost efficacy of eversion carotid endarterectomy (ECEA) with standard carotid endarterectomy (SCEA). Methods: A retrospective analysis of 88 carotid endarterectomies performed by the residents under the guidance of the senior author between January 1, 1991, and December 31, 1993, was done. Fifty-five patients underwent SCEA (44 vein patch, 11 primary closure) and 33 had ECEA. The two groups were compared for operative time, intraoperative evaluation, cost, immediate and delayed morbidity, and restenosis (≥ 50%). Results: The two groups were found to be similar for age, sex ratio, and associated diseases. The indications for surgery were transient ischemic attack (TIA) (57% ECEA, 64% SCEA), previous stroke with minimal residual deficit (9% ECEA, 17% SCEA), and asymptomatic high-grade stenosis (34% ECEA, 19% SCEA). The average operative time for ECEA was significantly less (99.2 vs 135.2 minutes, P < 0.02). The mean blood loss was also less for ECEA (86 vs 181 cc). Two SCEA patients had immediate postoperative thrombosis resulting in 1 cerebrovascular accident (CVA) (1.8%), and 3 SCEA patients had cranial nerve injuries. In follow-up, 1 patient with SCEA had restenosis and 1 had a CVA unrelated to carotid disease. Morbidity associated with ECEA included 1 unsuccessful ECEA requiring interposition vein grafting and 1 intraoperative repair of an intimal flap. There was no associated residual morbidity. There was no significant difference in stroke rate between the two groups. The operative cost (excluding surgeon fee) was 28% higher for SCEA patients. Conclusion: Eversion carotid endarterectomy is a safe procedure and can be an important addition to a surgeon's armamentarium in efforts to cut costs while maintaining quality.