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Titolo:
CAROTID ENDARTERECTOMY - THE MANDATE FOR HIGH-QUALITY DUPLEX
Autore:
ELMORE JR; FRANKLIN DP; THOMAS DD; YOUKEY JR;
Indirizzi:
GEISINGER MED CTR,VASC SURG SECT DANVILLE PA 17822
Titolo Testata:
Annals of vascular surgery
fascicolo: 2, volume: 12, anno: 1998,
pagine: 156 - 162
SICI:
0890-5096(1998)12:2<156:CE-TMF>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
12
Recensione:
Indirizzi per estratti:
Citazione:
J.R. Elmore et al., "CAROTID ENDARTERECTOMY - THE MANDATE FOR HIGH-QUALITY DUPLEX", Annals of vascular surgery, 12(2), 1998, pp. 156-162

Abstract

Excellent correlation between carotid angiography and duplex scanninghas made it possible to perform carotid endarterectomy without angiography. The accuracy of scans from practices without a dedicated vascular laboratory must be validated prior to their use for clinical decisions. Seventy six patients had a carotid duplex performed at an outsideinstitution and were referred for vascular surgery. All patients underwent a repeat study at our dedicated vascular lab. The overall accuracy of our lab was 93.8% for all carotid categories as demonstrated by angiography. Outside carotid duplex reports correlated with repeat exams as follows: occlusions: 10/13 carotids (76.9%); 80%-99% stenoses: 15/39 carotids (38.5%); 50%-79% stenoses: 28/44 carotids (63.6%). If a surgeon's practice is to operate for asymptomatic 80%-99% stenoses by report, then unnecessary surgery might have been performed in 61.5% ofthese carotids and appropriate surgery denied in 3.6%. Outside duplexvelocities consistent with a 60%-99% stenosis correlated in 13/17 carotids (76.5%). If a surgeon's practice is to operate for asymptomatic 60%-99% stenoses based on velocity criteria, then unnecessary surgery might have been performed in 23.5% of these carotids, and appropriate surgery denied in 7.6% placing these patients al increased risk of stroke. Outside scans significantly overestimated the severity of carotiddisease (p = 0.003). The weighted kappa analysis for agreement between scans was only 60.2%. Failure to have validated high-quality duplex in labs performing carotid studies can lead to unnecessary angiographyor surgery. Carotid endarterectomy without angiography should be performed only when duplex accuracy has been previously validated by angiographic correlation studies. Poor agreement with studies from practices without a dedicated vascular lab makes it mandatory to repeat the duplex on all patients prior to clinical decision making. Reimbursement for such repeat studies should not be denied.

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Documento generato il 06/08/20 alle ore 16:28:20