The role of vascular reconstructive surgery in the treatment of cerebrovascular insufficiency

• Published in: Bratislavské lékarské listy Vol. 97; no. 10; p. 629
• Main Authors: Sefránek, V, Tomka, J, Molcan, T, Dulka, T, Brezná, M, Stanová, L, Lesný, P, Mistrík, A, Lederer, P
• Format: Journal Article
• Language: Slovak
• Published: Slovakia 01-10-1996
• Subjects: Adult; Aged; Aged, 80 and over; Brain Ischemia - etiology; Brain Ischemia - surgery; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Postoperative Complications
• ISSN: 0006-9248

Management of cerebrovascular insufficiency (CVI) is one of the greatest medical challenges in our country. Retardation in this field has been causing serious medical and socioeconomic consequences.
In spite of existing unfavourable conditions the authors of this paper have managed to standardize their own policy in diagnosis, surgical indications and techniques. This caused substantial improvement of their results, as well as cooperation with the neurologic clinics. In connection with the increasing numbers of operations and improved results, the authors report their recent experience in this field and compare them with the results from previous years.
The authors compare two series of patients. The first series of 65 consecutive patients surgically treated from 1st Jan. 1987 to 31st Dec. 1990 (69 operations altogether). The 2nd series of 169 consecutive patients surgically treated from January 1st 1993 to December 31st 1994 (191 operations altogether), 149 due of them were subjected to carotid endarterectomy (CEA). Mean age of the first series was 55.3 (35-73), 2nd series 59.7 years (42-86). The authors have studied participation of neurologically and angiographically unstable patients. In the first series the ratio of neurologically stable and unstable patients was 63.4:36.6%, while in the 2nd series it was 75.4:24.6%. The ratio of angiographically stable and unstable patients was in the 1st series 60.2:39.8%, while in the 2nd series it was 50.3:49.7%. In the 2nd series the authors observed also the percent age of ulcerated lesions in the carotid bifurcation and found a surprisingly high number-59.2%.
The combined mortality-morbidity index of the first series was 11.6%, of the 2nd series 3.1%. In the first series there were two deaths (2.9%) and 6 brain infarctions. In the 2nd series four patients died from acute myocardial infarction (2.1%) and there were two cases of a perioperative brain infarction, respectively. The necessity of wound revision due to of bleeding was found in two patients (2.9%) in the first series, and in two cases (1%) in the 2nd series.
The authors emphasize the complicated nature of these problems, the necessity to recognize the surgical indications and techniques, and protective measures to prevent serious complications. There is, in their opinion, inevitable to increase bringing the patients in need of surgical reconstruction under control. On the other hand, there is the necessity to increase the accessibility of qualified surgery in the CVI. That means in the first place to increase the number of centers able to accomplish these operations with minimal combined mortality-morbidity index. (Tab. 10, Ref. 37.).