The outcome of external carotid endarterectomy during routine carotid endarterectomy

Purpose: This study is an analysis of the outcome of a common method of management of the external carotid artery (ECA) during routine carotid endarterectomy (CEA). Methods: Between 1986 and 1997, 1069 primary CEAs were performed with a combination of proximal eversion technique and blind distal endarterectomy on the ECA. Of these, 973 CEAs (91%) had 1 or more postoperative duplex scans that included the ECA. Both preoperative and early postoperative studies were performed on 313 of these CEAs. Intraoperative post-CEA continuous-wave Doppler scans identified low flow or occlusion of the ECA in 37 CEAs (4%). These ECAs were isolated and repaired. Results: The early post-CEA duplex scan velocities were 143 ± 81 cm/s (mean ± l standard deviation of the mean). In the first 6 months after the CEAs, 692 ECAs (72%) had <50% stenosis, 175 (18%) had 50% to 74% stenosis, 90 (9%) had ≥75% stenosis, and 9 (1%) were occluded. Of the 37 repaired ECAs, 20 (54%) had <50% stenosis, 10 (27%) had 50% to 74% stenosis, 5 (14%) had ≥75% stenosis, and 2 (5%) were occluded. The cumulative life-table ≥50% stenosis rate was 36% at 1 year, 40% at 3 years, 48% at 5 years, and 81% at 10 years. The cumulative ≥75% stenosis rate was 12% at 1 year, 12% at 3 years, 15% at 5 years, and 37% at 10 years. Preoperative studies showed <50% stenosis in 152 of the 313 ECAs (48%). In the early postoperative period, 102 of these ECAs (66%) had <50% stenosis, 35 (23%) had 50% to 74% stenosis, 13 (9%) had ≥75% stenosis, and 3 (2%) were occluded. Of the 161 ECAs with ≥50% preoperative stenosis, 66 (41%) had <50% stenosis in the first 6 months after CEA, 61 (38%) had 50% to 74% stenosis, 32 (20%) had ≥75% stenosis, and 2 (1%) were occluded. Conclusions: Combined proximal eversion technique and blind distal ECA endarterectomy during routine CEA gives poor and unacceptable early and late outcomes. The repair of severely obstructed or occluded ECA identified during surgery after CEA has a similarly poor outcome. The technique and management of the ECA during routine CEA needs further investigation and modification. (J Vasc Surg 1998;28:585-90.)