Rashid Usman, Muhammad Jamil.
Carotid Endarterectomy under Local Anaesthesia is Safe and Effective in High Risk Elderly patients.
J Surg Pak Jan ;20(4):151-4.

Objective: To assess the safety and effectiveness of carotid endarterectomy (CEA) under local anaesthesia (LA) in high risk elderly patients. Study design: Descriptive case series. Place & Duration of study: Department of Vascular Surgery Combined Military Hospital Lahore, from January 2011 to January 2015. Methodology: Patients with 70% or more stenosis of internal carotid artery in asymptomatic patients while 50% or more in patients with symptomatic carotid artery disease on duplex scanning were included. They underwent endarterectomy under local anaesthesia. The indication of surgery, hospital stay, complications and mortality were noted. Results: A total of 126 CEA in 112 patients (96 males and 16 females) were performed under LA. Four (3.1%) cases were converted to general anaesthesia (GA). Shunt was used selectively in 6 (4.7%) cases with bilateral severe carotid artery occlusive disease. Perioperative transient ischaemic attack occurred in 3 (2.3%) patients and permanent neurological deficit in one (0.8%) patient. There was no mortality in this series. The postoperative complications included haematoma formation in 4 (3.1%), bleeding in 3 (2.3%), temporary dropping of lower lip in 1 (0.8%) and pseudoaneurysm formation in 1 (0.8%) patient. Hospital stay ranged from 24 to 96 hours. Mean stay in patients who had CEA under LA was 28 hours while it was 52 hours in those who needed conversion to GA. Conclusion: Carotid endarterectomy under local anaesthesia is safe and effective procedure in elderly and high risk patients.

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