Cervical Hematoma Following Carotid Endarterectomy is Morbid and Preventable

Abstract

Objective: Cervical hematoma (CH) following carotid endarterectomy (CEA) is a serious complication. We reviewed 12 years of CEA for CH requiring operative evacuation to determine its impact on the patient outcome and relationship to perioperative pharmacotherapy. Methods: A total of 2643 CEAs were reviewed. In all, 57 CHs requiring operative evacuation were compared to all the patients for general characteristics and with a case-controlled cohort group for pharmacologic details. Results: The occurrence of CH was stable from 1994 to 1998 and then increased from 1999 to 2003. The CH increased operative mortality, neurologic complications, adverse cardiac events, and cranial nerve injury. Combined platelet inhibition and dextran alone increased the risk of CH. The CH rate dropped by 65% after the observations were reported to the vascular surgeons. Conclusion: The CH following CEA requiring operative evacuation is associated with increased postoperative mortality and cardiac and neurologic morbidity. Combined platelet inhibition, use of dextran, and elevated creatinine are causally related to CH. Physician awareness and modified pharmacotherapy have decreased the problem.