Evolution of practices in carotid surgery: from 2006 to 2015

Carotid artery intervention or surgery is less often performed in our hospital for various reasons when compared to the more often performed coronary artery surgery and interventions.. Similarly in the last 10 years, this has not changed significantly. In addition the high dose statin therapy and best medical therapies are gaining popular in many hospital. Early initiation of best medical therapies helping the patients to prevent the next event. It is still very difficult to do carotid endarterectomy in the early window period (golden period is less than a week after indexed event TIA) due to many factors which delay the entry of the patient to the operation theatre. As the time passes the risk drops and patients also postpone it further.

An observational analysis showed stability in the number of carotid procedures performed during the period and a progressive modification of carotid surgery practices in France, in accordance with the recommendations of learned societies and major publications. We also feel that seems to be fact in many other hospitals.



Reference

Salomon du Mont, Lucie et al.. Evolution of practices in carotid surgery: observational study in France from 2006 to 2015.   Annals of Vascular Surgery , Volume 0 , Issue 0 ,

http://www.annalsofvascularsurgery.com/article/S0890-5096(17)30325-4/fulltext 

Smoking cessation rates amongst patients undergoing vascular surgery

Vascular surgeons and interventionists explain the patients and suggest them to stop smoking in the perioperative period. But some of them fail to stop smoking due to various reasons. Recurrence of the stenotic lesions and thrombosis is known to be higher in such people. In our hospital 25% of the patients stop smoking forever. 50% of patients stop smoking for some time and restart after discharge. 25% of smokers never stop smoking.

Smoking is the single most important modifiable risk factor for patients with vascular disease. A study was done in Canada with an aim to determine prevalence of smoking and cessation rates amongst patients undergoing vascular surgery.

Results  of that study - Overall 624 patients had complete follow up data. Of these, 209 (33.5%) were smokers pre-surgically. At 1 year follow up of those 209 patients who were smokers pre-op, 87 (41.6%) had stopped smoking while 122 (58.4%) had not. Patients who were male and aged >70 were more likely to be smokers pre-operatively (p=0.001 and p<0 .001="" aged="" cessation="" in="" increased="" rates="" respectively="" those="" were="">70 years (p=0.005), and in those with COPD (p=0.016). Gender was also statistically associated, with cessation rates higher in females (p=0.011).

They concluded by saying that,  more than one-third of patients who underwent surgery in a Canadian vascular center continue to smoke.  

May be, we should study the outcomes of vascular treatments after improving this difficult habit (smoking cessation) further. We should do a study targeting the smoking habit and then measuring the outcomes of the vascular procedures. The attention is needed in this direction at this hour.

Reference

McHugh, S.M. et al. Smoking cessation rates amongst patients undergoing vascular surgery in a Canadian center.  .Annals of Vascular Surgery , Volume 0 , Issue 0 ,  article in press

http://www.annalsofvascularsurgery.com/article/S0890-5096(16)31348-6/fulltext