FOR HOW LONG SHOULD CAROTID ENDARTERECTOMY SURVEILLANCE BE CONTINUED

Early restenosis represent the most important and more common failure after carotid endarterectomy. For this reason, after its first description made in 1976 by Stoney and String, it raised general interest among vascular surgeons. In spite of the efforts to clear the causes of this phenomenon, none of the numerous papers published in the literature has defined a specific cause determining restenosis. Nevertheless, at present, this hyperplastic response of the arterial wall to trauma after operation is generally considered benign because it is rarely responsible for new neurological symptoms or early internal carotid artery occlusion. This unanimous conviction has been achieved after years of instrumental and clinical postoperative follow-up performed all over the world. At the same time and probably for these reasons, recently, a new discussion has begun about the usefulness and cost-effectiveness of prolonged Duplex scanning postoperative surveillance of the endarterectomized carotid arteries. This new question raised our curiosity in verifying the validity of this new approach, so we reviewed accurately our laboratory follow-up registry and the data regarding onset, evolution and clinical outcome of early restenosis. These data associated with a meticulous review of the experience of other authors convinced us that the patients operated on, need, in most cases, a short even aggressive period of careful follow-up (generally the first six months). If during this period no irregularities or new stenosis is detected at the site of the endarterectomy, we, in agreement with others, believe that it is justified that the patients can be withdrawn from a prolonged instrumental follow-up, permitting laboratory working time to be redirected towards the diagnosis of new vascular diseases.