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Erschienen in: European Surgery 6/2014

01.12.2014 | Main Topic

Postoperative blood pressure in patients undergoing eversion carotid endarterectomy with or without resection of the carotid sinus nerve

verfasst von: K. Linni, MD, M. Aspalter, MD, Doz. D. Neureiter, Doz. W. Hitzl, Prof. H. Magometschnigg, Prof. T. Hölzenbein

Erschienen in: European Surgery | Ausgabe 6/2014

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Summary

Background

The carotid sinus nerve (CSN) is important for regulation of blood pressure (BP) and heart rate. The aim of our study was to investigate whether dissection of the carotid bifurcation during eversion carotid endarterectomy (eCEA) causes a histologically proven compromise of the CSN and how the postoperative BP was affected thereby.

Methods

Consecutive patients undergoing eCEA for primary high-grade internal carotid artery (ICA) stenosis without contralateral pathology were selected for this study. In all patients, histological specimens of the periadventitial tissue within the carotid bifurcation were taken during eCEA. Nerval structures of the CSN within the carotid bifurcation were detected by immunohistochemistry. BP was continuously monitored postoperatively.

Results

From March 2007 to March 2008, 100 patients were selected. In 55 patients (Group A), nerval structures could be detected within specimens resected during eCEA. In 45 patients (Group B), nerval structures could not be found histologically. Both groups were equal regarding cardiovascular risk factors, degree of ICA stenosis, and indication for surgery. There was a significant difference of diastolic BP values between Group A and B 7 h postoperatively (p = 0.005). We observed a significant difference of mean systolic BP values between both groups 30 days after operation (p = 0.011). All other mean BP values were equal between both groups at any point of time.

Conclusions

Our study showed that eCEA does not always imply a histologically proven compromise of the CSN and that BP is mainly equal in patients with and without histologically proven compromise of the CSN.
Literatur
1.
Zurück zum Zitat Toorop RJ, Scheltinga MR, Moll FL, Bleys RL. Anatomy of the carotid sinus nerve and surgical implications in carotid sinus syndrome. J Vasc Surg. 2009;50:177–82. PubMedCrossRef Toorop RJ, Scheltinga MR, Moll FL, Bleys RL. Anatomy of the carotid sinus nerve and surgical implications in carotid sinus syndrome. J Vasc Surg. 2009;50:177–82. PubMedCrossRef
2.
Zurück zum Zitat Angell-James JE, Lumley JAP. The effects of CEA on the mechanical properties of the carotid sinus and carotid sinus nerve activity in atherosclerotic patients. Br J Surg. 1974;61:806–10. CrossRef Angell-James JE, Lumley JAP. The effects of CEA on the mechanical properties of the carotid sinus and carotid sinus nerve activity in atherosclerotic patients. Br J Surg. 1974;61:806–10. CrossRef
3.
Zurück zum Zitat Thrasher T. Unloading arterial baroreceptors causes neurogenic hypertension. Am J Physiol Regul Integr Comp Physiol. 2002;282:R1044–53. PubMed Thrasher T. Unloading arterial baroreceptors causes neurogenic hypertension. Am J Physiol Regul Integr Comp Physiol. 2002;282:R1044–53. PubMed
4.
Zurück zum Zitat Angell-James JE. Arterial baroreceptor activity in rabbits with experimental atherosclerosis. Circ Res. 1974;34:27–39. CrossRef Angell-James JE. Arterial baroreceptor activity in rabbits with experimental atherosclerosis. Circ Res. 1974;34:27–39. CrossRef
5.
6.
Zurück zum Zitat Omlor G, Schröder J, Müller M, Behnke S, Lindemann W, Meyer A. Optimierung der Ergebnisse nach Karotis-TEA durch “No-touch-isolation-Technik” und intraoperative Angiographie. Gefässchirurgie. 2000;5:99–104. CrossRef Omlor G, Schröder J, Müller M, Behnke S, Lindemann W, Meyer A. Optimierung der Ergebnisse nach Karotis-TEA durch “No-touch-isolation-Technik” und intraoperative Angiographie. Gefässchirurgie. 2000;5:99–104. CrossRef
7.
Zurück zum Zitat Raithel D, Kasprzak PM. The eversion endarterectomy—a new technique. In: Greenhalgh RM, Hollier LJ, editors. Surgery for stroke. London: WB Saunders; 1993. S. 183–9. Raithel D, Kasprzak PM. The eversion endarterectomy—a new technique. In: Greenhalgh RM, Hollier LJ, editors. Surgery for stroke. London: WB Saunders; 1993. S. 183–9.
8.
Zurück zum Zitat Shah DM, Darling RC III, Chang BB, et al. Carotid endarterectomy by eversion technique: its safety and durability. Ann Surg. 1998;228:471–8. Shah DM, Darling RC III, Chang BB, et al. Carotid endarterectomy by eversion technique: its safety and durability. Ann Surg. 1998;228:471–8.
9.
Zurück zum Zitat Rössel T, Litz RJ, Heller AR, Koch T.  Anästhesie zur Karotischirurgie. Anaesthesist. 2008;57:115–30. PubMedCrossRef Rössel T, Litz RJ, Heller AR, Koch T.  Anästhesie zur Karotischirurgie. Anaesthesist. 2008;57:115–30. PubMedCrossRef
10.
Zurück zum Zitat Towne JB, Bernhard VM. The relationship of postoperative hypertension to complications following carotid endarterectomy. Surgery. 1980;88:575–80. PubMed Towne JB, Bernhard VM. The relationship of postoperative hypertension to complications following carotid endarterectomy. Surgery. 1980;88:575–80. PubMed
11.
Zurück zum Zitat Lehv MS, Salzman EW, Silen W. Hypertension complicating carotid endarterectomy. Stroke. 1970;1:307–13. PubMedCrossRef Lehv MS, Salzman EW, Silen W. Hypertension complicating carotid endarterectomy. Stroke. 1970;1:307–13. PubMedCrossRef
12.
Zurück zum Zitat Skudlorick JH, Mooring SL. Systolic hypertensions and complications of CEA. South Med J. 1982;12:1563–5. CrossRef Skudlorick JH, Mooring SL. Systolic hypertensions and complications of CEA. South Med J. 1982;12:1563–5. CrossRef
13.
Zurück zum Zitat Bove EL, Fry WJ, Gross WS, Stanley JC. Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy. Surgery. 1979;85:633–7. PubMed Bove EL, Fry WJ, Gross WS, Stanley JC. Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy. Surgery. 1979;85:633–7. PubMed
14.
Zurück zum Zitat Hertzer NR, Lees CD. Fatal myocardial infarction following carotid endarterectomy: three hundred thirty-five patients followed 6–11 years after operation. Ann Surg. 1981;194:212–8. PubMedCentralPubMedCrossRef Hertzer NR, Lees CD. Fatal myocardial infarction following carotid endarterectomy: three hundred thirty-five patients followed 6–11 years after operation. Ann Surg. 1981;194:212–8. PubMedCentralPubMedCrossRef
15.
Zurück zum Zitat Smit A, Timmers H, Wieling W, et al. Long-term effects of carotid sinus denervation on arterial blood pressure in humans. Circulation. 2002;105:1329–35. PubMedCrossRef Smit A, Timmers H, Wieling W, et al. Long-term effects of carotid sinus denervation on arterial blood pressure in humans. Circulation. 2002;105:1329–35. PubMedCrossRef
16.
Zurück zum Zitat Mehta M, Rahmani O, Dietzek AM, et al. Eversion technique increases the risk for post-carotid endarterectomy hypertension. J Vasc Surg. 2001;34:839–45. PubMedCrossRef Mehta M, Rahmani O, Dietzek AM, et al. Eversion technique increases the risk for post-carotid endarterectomy hypertension. J Vasc Surg. 2001;34:839–45. PubMedCrossRef
17.
Zurück zum Zitat Wilfert K, Drischel K, Unbehaun A, Guski H, Persson PB, Strauss HM. Vascular response to angiotensin II in atherosclerosis: role of the baroreflex. Hypertension. 2000;35:685–90. PubMedCrossRef Wilfert K, Drischel K, Unbehaun A, Guski H, Persson PB, Strauss HM. Vascular response to angiotensin II in atherosclerosis: role of the baroreflex. Hypertension. 2000;35:685–90. PubMedCrossRef
18.
Zurück zum Zitat Vlachakis ND, Mendelowitz M, DeGuia D, DeGusman D. Diminished baroreceptor sensitivity in elderly hypertensives: possible role of atherosclerosis. Atherosclerosis. 1976;24:243–9. PubMedCrossRef Vlachakis ND, Mendelowitz M, DeGuia D, DeGusman D. Diminished baroreceptor sensitivity in elderly hypertensives: possible role of atherosclerosis. Atherosclerosis. 1976;24:243–9. PubMedCrossRef
19.
Zurück zum Zitat Laitinen T, Hartikainen J, Vanninen E, Niskanen L, Geelen G, Lansimies EA. Age and gender dependency of baroreflex sensitivity in healthy subjects. J Appl Physiol. 1998;84:576–83. PubMed Laitinen T, Hartikainen J, Vanninen E, Niskanen L, Geelen G, Lansimies EA. Age and gender dependency of baroreflex sensitivity in healthy subjects. J Appl Physiol. 1998;84:576–83. PubMed
20.
Zurück zum Zitat Bristow JD, Honour AJ, Pickering GW, Sleight P, Smyth HS. Diminished baroreflex sensitivity in high blood pressure. Circulation. 1969;34:48–54. CrossRef Bristow JD, Honour AJ, Pickering GW, Sleight P, Smyth HS. Diminished baroreflex sensitivity in high blood pressure. Circulation. 1969;34:48–54. CrossRef
21.
Zurück zum Zitat Pomidossi G, Saino A, Perondi R, et al. Impairment of the arterial baroreflex during symptomatic and silent myocardial ischemia in humans. J Am Coll Cardiol. 1992;22:1866–72. CrossRef Pomidossi G, Saino A, Perondi R, et al. Impairment of the arterial baroreflex during symptomatic and silent myocardial ischemia in humans. J Am Coll Cardiol. 1992;22:1866–72. CrossRef
22.
Zurück zum Zitat James MA, Robinson TG, Panerai RB, Potter JF. Arterial baroreceptor-cardiac reflex sensitivity in the elderly. Hypertension. 1996;28:953–60. PubMedCrossRef James MA, Robinson TG, Panerai RB, Potter JF. Arterial baroreceptor-cardiac reflex sensitivity in the elderly. Hypertension. 1996;28:953–60. PubMedCrossRef
23.
Zurück zum Zitat Chapleau MW, Hajduczok G, Abboud FM. Peripheral and central mechanisms of baroreflex resetting. Clin Exp Pharmacol Physiol. 1989;15:31–43. CrossRef Chapleau MW, Hajduczok G, Abboud FM. Peripheral and central mechanisms of baroreflex resetting. Clin Exp Pharmacol Physiol. 1989;15:31–43. CrossRef
24.
Zurück zum Zitat Uchida Y. Afferent aortic nerve fibers with their pathways in cardiac sympathetic nerves. Am J Physiol. 1975;228:990–5. PubMed Uchida Y. Afferent aortic nerve fibers with their pathways in cardiac sympathetic nerves. Am J Physiol. 1975;228:990–5. PubMed
25.
Zurück zum Zitat Nouraei SAR, Al-Rawi PG, Sigaudo-Roussel D, Guissani DA, Gaunt ME. Carotid endarterectomy impairs blood pressure homeostasis by reducing the physiologic baroreflex reserve. J Vasc Surg. 2005;41:631–7. PubMedCrossRef Nouraei SAR, Al-Rawi PG, Sigaudo-Roussel D, Guissani DA, Gaunt ME. Carotid endarterectomy impairs blood pressure homeostasis by reducing the physiologic baroreflex reserve. J Vasc Surg. 2005;41:631–7. PubMedCrossRef
Metadaten
Titel
Postoperative blood pressure in patients undergoing eversion carotid endarterectomy with or without resection of the carotid sinus nerve
verfasst von
K. Linni, MD
M. Aspalter, MD
Doz. D. Neureiter
Doz. W. Hitzl
Prof. H. Magometschnigg
Prof. T. Hölzenbein
Publikationsdatum
01.12.2014
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 6/2014
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-014-0267-7

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