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J Chest Surg

Published online November 9, 2022

Copyright © Journal of Chest Surgery.

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

Byeng Hun Jeon, M.D. , Chul Ho Lee, M.D. , Jae Seok Jang, M.D. , Jun Woo Cho, M.D.

Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea

Correspondence to:Jun Woo Cho
Tel 82-53-650-4566
Fax 82-53-629-6963
E-mail jojunwu1@cu.ac.kr
ORCID
https://orcid.org/0000-0002-0786-9775

Received: June 24, 2022; Revised: August 31, 2022; Accepted: September 15, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Carotid endarterectomy (CEA) is used to treat carotid stenosis, which is associated with cerebral infarction and may result in neurologic deficits such as stroke, transient ischemic attack (TIA), and local nerve injury. To decrease surgery-related complications and improve patient satisfaction with esthetic outcomes, efforts have been made to minimize incision size instead of using a standard longitudinal incision.
Methods: We performed a retrospective analysis of 151 cases of CEA, of which 110 used conventional incisions and 41 used high mini-skin incisions (HMIs), from March 2015 to December 2021 at a single institution. Short-term (30-day) postoperative results were evaluated for rates of mortality, stroke, TIA, and cranial/cervical nerve injuries. Risk factors for nerve injury were also assessed.
Results: The HMI group showed significantly (p<0.01) shorter operative and clamp times than the conventional group. The HMI group also had significantly shorter incision lengths (5.3±0.9 cm) than the conventional group (11.5±2.8 cm). The rates of stroke, TIA, and death at 30 days were not significantly different between the 2 groups. There was no significant difference in the rate of cranial and cervical nerve injuries, and all injuries were transient. A high lesion level (odds ratio [OR], 9.56; 95% confidence interval [CI], 3.21−28.42; p<0.01) and the clamp time (OR, 1.07; 95% CI, 1.03−1.12; p<0.01) were found to be risk factors for nerve injuries.
Conclusion: Use of the HMI in CEA for carotid stenosis was advantageous for its shorter operative time, shorter internal carotid artery clamp time, reduced neurologic complications, and improved esthetics.

Keywords: Carotid endarterectomy, Mini-skin incision, Cranial and cervical nerve, Carotid stenosis

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J Chest Surg

Published online November 9, 2022

Copyright © Journal of Chest Surgery.

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

Byeng Hun Jeon, M.D. , Chul Ho Lee, M.D. , Jae Seok Jang, M.D. , Jun Woo Cho, M.D.

Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Korea

Correspondence to:Jun Woo Cho
Tel 82-53-650-4566
Fax 82-53-629-6963
E-mail jojunwu1@cu.ac.kr
ORCID
https://orcid.org/0000-0002-0786-9775

Received: June 24, 2022; Revised: August 31, 2022; Accepted: September 15, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Carotid endarterectomy (CEA) is used to treat carotid stenosis, which is associated with cerebral infarction and may result in neurologic deficits such as stroke, transient ischemic attack (TIA), and local nerve injury. To decrease surgery-related complications and improve patient satisfaction with esthetic outcomes, efforts have been made to minimize incision size instead of using a standard longitudinal incision.
Methods: We performed a retrospective analysis of 151 cases of CEA, of which 110 used conventional incisions and 41 used high mini-skin incisions (HMIs), from March 2015 to December 2021 at a single institution. Short-term (30-day) postoperative results were evaluated for rates of mortality, stroke, TIA, and cranial/cervical nerve injuries. Risk factors for nerve injury were also assessed.
Results: The HMI group showed significantly (p<0.01) shorter operative and clamp times than the conventional group. The HMI group also had significantly shorter incision lengths (5.3±0.9 cm) than the conventional group (11.5±2.8 cm). The rates of stroke, TIA, and death at 30 days were not significantly different between the 2 groups. There was no significant difference in the rate of cranial and cervical nerve injuries, and all injuries were transient. A high lesion level (odds ratio [OR], 9.56; 95% confidence interval [CI], 3.21−28.42; p<0.01) and the clamp time (OR, 1.07; 95% CI, 1.03−1.12; p<0.01) were found to be risk factors for nerve injuries.
Conclusion: Use of the HMI in CEA for carotid stenosis was advantageous for its shorter operative time, shorter internal carotid artery clamp time, reduced neurologic complications, and improved esthetics.

Keywords: Carotid endarterectomy, Mini-skin incision, Cranial and cervical nerve, Carotid stenosis

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