Renal insufficiency and altered postoperative risk in carotid endarterectomy
Purpose: Higher complication rates have been reported in patients with renal insufficiency (RI) undergoing peripheral vascular surgery. Little attention has been paid specifically to carotid endarterectomy (CEA) in patients with RI where the risk/benefit considerations are very sensitive to small in...
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| Veröffentlicht in: | Journal of vascular surgery 1999-06, Vol.29 (6), p.1006-1011 |
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| container_title | Journal of vascular surgery |
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| creator | Hamdan, Allen D. Pomposelli, Frank B. Gibbons, Gary W. Campbell, David R. LoGerfo, Frank W. |
| description | Purpose: Higher complication rates have been reported in patients with renal insufficiency (RI) undergoing peripheral vascular surgery. Little attention has been paid specifically to carotid endarterectomy (CEA) in patients with RI where the risk/benefit considerations are very sensitive to small increases in postoperative complications.
Methods: One thousand one consecutive CEAs performed since 1990 were reviewed from our vascular registry, and 73 CEAs on patients with RI were identified. For comparison, two groups were established: group I (n = 928), normal renal function (creatinine level, |
| doi_str_mv | 10.1016/S0741-5214(99)70241-7 |
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Methods: One thousand one consecutive CEAs performed since 1990 were reviewed from our vascular registry, and 73 CEAs on patients with RI were identified. For comparison, two groups were established: group I (n = 928), normal renal function (creatinine level, <1.5 mg/dL); and group II (n = 73), RI (creatinine level, ≥1.5 mg/dL).
Results: Differences in the nonfatal stroke rates and combined stroke and death rates were statistically significant (
P < .02) between the groups: group I (1.08% and 1.18%) and group II (5.56% and 6.94%) respectively. Both groups were similar in regard to operative indications. In addition with the comparison of group I to group II, there was a statistically significant increase in hematoma rate, 1.61% versus 12.5% (
P < .001), total cardiac morbidity, 1.72% versus 6.94% (
P = .003), and total complications, 6.24% versus 36.1% (
P = .001). Multivariate analysis demonstrated pre-existing RI to be the only significant predictor for perioperative stroke and hematoma.
Conclusion: Patients with preoperative RI are at a higher, but not prohibitive, risk for stroke and death after CEA than patients with normal renal function. They are also at risk for hematoma formation, cardiac morbidity, and overall complications. Care in selection of these patients for CEA must be emphasized. (J Vasc Surg 1999;29:1006-11.)</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/S0741-5214(99)70241-7</identifier><identifier>PMID: 10359934</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aged ; Carotid Stenosis - blood ; Carotid Stenosis - complications ; Carotid Stenosis - surgery ; Creatinine - blood ; Endarterectomy, Carotid - adverse effects ; Female ; Heart Diseases - etiology ; Hematoma - etiology ; Humans ; Kidney Failure, Chronic - blood ; Kidney Failure, Chronic - complications ; Male ; Risk ; Stroke - etiology</subject><ispartof>Journal of vascular surgery, 1999-06, Vol.29 (6), p.1006-1011</ispartof><rights>1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-87ae99cb93dac3e81e4d5268f2878b16bc232c0e6d99791bb2de45e3643e8a7f3</citedby><cites>FETCH-LOGICAL-c474t-87ae99cb93dac3e81e4d5268f2878b16bc232c0e6d99791bb2de45e3643e8a7f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0741-5214(99)70241-7$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10359934$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hamdan, Allen D.</creatorcontrib><creatorcontrib>Pomposelli, Frank B.</creatorcontrib><creatorcontrib>Gibbons, Gary W.</creatorcontrib><creatorcontrib>Campbell, David R.</creatorcontrib><creatorcontrib>LoGerfo, Frank W.</creatorcontrib><title>Renal insufficiency and altered postoperative risk in carotid endarterectomy</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Purpose: Higher complication rates have been reported in patients with renal insufficiency (RI) undergoing peripheral vascular surgery. Little attention has been paid specifically to carotid endarterectomy (CEA) in patients with RI where the risk/benefit considerations are very sensitive to small increases in postoperative complications.
Methods: One thousand one consecutive CEAs performed since 1990 were reviewed from our vascular registry, and 73 CEAs on patients with RI were identified. For comparison, two groups were established: group I (n = 928), normal renal function (creatinine level, <1.5 mg/dL); and group II (n = 73), RI (creatinine level, ≥1.5 mg/dL).
Results: Differences in the nonfatal stroke rates and combined stroke and death rates were statistically significant (
P < .02) between the groups: group I (1.08% and 1.18%) and group II (5.56% and 6.94%) respectively. Both groups were similar in regard to operative indications. In addition with the comparison of group I to group II, there was a statistically significant increase in hematoma rate, 1.61% versus 12.5% (
P < .001), total cardiac morbidity, 1.72% versus 6.94% (
P = .003), and total complications, 6.24% versus 36.1% (
P = .001). Multivariate analysis demonstrated pre-existing RI to be the only significant predictor for perioperative stroke and hematoma.
Conclusion: Patients with preoperative RI are at a higher, but not prohibitive, risk for stroke and death after CEA than patients with normal renal function. They are also at risk for hematoma formation, cardiac morbidity, and overall complications. Care in selection of these patients for CEA must be emphasized. (J Vasc Surg 1999;29:1006-11.)</description><subject>Aged</subject><subject>Carotid Stenosis - blood</subject><subject>Carotid Stenosis - complications</subject><subject>Carotid Stenosis - surgery</subject><subject>Creatinine - blood</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Female</subject><subject>Heart Diseases - etiology</subject><subject>Hematoma - etiology</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - blood</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Male</subject><subject>Risk</subject><subject>Stroke - etiology</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1LxDAQhoMouq7-BKUn0UM1SdOkOYksfsGC4Mc5pMkUom2zJu3C_nvb7SLePA0Dzzsv8yB0RvA1wYTfvGHBSJpTwi6lvBKYDpvYQzOCpUh5geU-mv0iR-g4xk-MCckLcYiOCM5yKTM2Q8tXaHWduDb2VeWMg9ZsEt3aRNcdBLDJysfOryDozq0hCS5-DXBidPCdswm0VocRNJ1vNifooNJ1hNPdnKOPh_v3xVO6fHl8XtwtU8ME69JCaJDSlDKz2mRQEGA2p7yoaCGKkvDS0IwaDNxKKSQpS2qB5ZBxNsBaVNkcXUx3V8F_9xA71bhooK51C76PisuCYC7oAOYTaIKPMUClVsE1OmwUwWrUqLYa1ehISam2GpUYcue7gr5swP5JTd4G4HYCYHhz7SCouHUH1o0ulPXun4ofqhiDMg</recordid><startdate>19990601</startdate><enddate>19990601</enddate><creator>Hamdan, Allen D.</creator><creator>Pomposelli, Frank B.</creator><creator>Gibbons, Gary W.</creator><creator>Campbell, David R.</creator><creator>LoGerfo, Frank W.</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990601</creationdate><title>Renal insufficiency and altered postoperative risk in carotid endarterectomy</title><author>Hamdan, Allen D. ; Pomposelli, Frank B. ; Gibbons, Gary W. ; Campbell, David R. ; LoGerfo, Frank W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-87ae99cb93dac3e81e4d5268f2878b16bc232c0e6d99791bb2de45e3643e8a7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Carotid Stenosis - blood</topic><topic>Carotid Stenosis - complications</topic><topic>Carotid Stenosis - surgery</topic><topic>Creatinine - blood</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Female</topic><topic>Heart Diseases - etiology</topic><topic>Hematoma - etiology</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - blood</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Male</topic><topic>Risk</topic><topic>Stroke - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hamdan, Allen D.</creatorcontrib><creatorcontrib>Pomposelli, Frank B.</creatorcontrib><creatorcontrib>Gibbons, Gary W.</creatorcontrib><creatorcontrib>Campbell, David R.</creatorcontrib><creatorcontrib>LoGerfo, Frank W.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hamdan, Allen D.</au><au>Pomposelli, Frank B.</au><au>Gibbons, Gary W.</au><au>Campbell, David R.</au><au>LoGerfo, Frank W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renal insufficiency and altered postoperative risk in carotid endarterectomy</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>1999-06-01</date><risdate>1999</risdate><volume>29</volume><issue>6</issue><spage>1006</spage><epage>1011</epage><pages>1006-1011</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Purpose: Higher complication rates have been reported in patients with renal insufficiency (RI) undergoing peripheral vascular surgery. Little attention has been paid specifically to carotid endarterectomy (CEA) in patients with RI where the risk/benefit considerations are very sensitive to small increases in postoperative complications.
Methods: One thousand one consecutive CEAs performed since 1990 were reviewed from our vascular registry, and 73 CEAs on patients with RI were identified. For comparison, two groups were established: group I (n = 928), normal renal function (creatinine level, <1.5 mg/dL); and group II (n = 73), RI (creatinine level, ≥1.5 mg/dL).
Results: Differences in the nonfatal stroke rates and combined stroke and death rates were statistically significant (
P < .02) between the groups: group I (1.08% and 1.18%) and group II (5.56% and 6.94%) respectively. Both groups were similar in regard to operative indications. In addition with the comparison of group I to group II, there was a statistically significant increase in hematoma rate, 1.61% versus 12.5% (
P < .001), total cardiac morbidity, 1.72% versus 6.94% (
P = .003), and total complications, 6.24% versus 36.1% (
P = .001). Multivariate analysis demonstrated pre-existing RI to be the only significant predictor for perioperative stroke and hematoma.
Conclusion: Patients with preoperative RI are at a higher, but not prohibitive, risk for stroke and death after CEA than patients with normal renal function. They are also at risk for hematoma formation, cardiac morbidity, and overall complications. Care in selection of these patients for CEA must be emphasized. (J Vasc Surg 1999;29:1006-11.)</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>10359934</pmid><doi>10.1016/S0741-5214(99)70241-7</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Carotid Stenosis - blood Carotid Stenosis - complications Carotid Stenosis - surgery Creatinine - blood Endarterectomy, Carotid - adverse effects Female Heart Diseases - etiology Hematoma - etiology Humans Kidney Failure, Chronic - blood Kidney Failure, Chronic - complications Male Risk Stroke - etiology |
| title | Renal insufficiency and altered postoperative risk in carotid endarterectomy |
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