A Systematic Review of Clinical Outcomes After Carotid Artery Ligation Versus Carotid Artery Reconstruction Following Venoarterial Extracorporeal Membrane Oxygenation in Infants and Children.

INTRODUCTION: In pediatric and neonatal populations, the carotid artery is commonly cannulated for venoarterial (VA) extracorporeal membrane oxygenation (ECMO). The decision to ligate (carotid artery ligation [CAL]) versus reconstruct (carotid artery reconstruction [CAR]) the artery at decannulation remains controversial as long-term neurologic outcomes remain unknown. The objective of this study was to summarize current literature on clinical outcomes following CAL and CAR after Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). METHODS: PubMed (MEDLINE), Embase, Web of Science, and Cochrane databases were searched using keywords from January 1950 to October 2020. Studies examining clinical outcomes following CAL and CAR for VA-ECMO in patients <18 y of age were included. Prospective and retrospective cohort studies, case series, case-control studies, and case reports were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were performed independently by two reviewers. Assessment of risk of bias was performed. RESULTS: Eighty studies were included and classified into four categories: noncomparative clinical outcomes after CAL (n = 23, 28.8%), noncomparative clinical outcomes after CAR (n = 12, 15.0%), comparative clinical outcomes after CAL and/or CAR (n = 28, 35.0%), and case reports of clinical outcomes after CAL and/or CAR (n = 17, 21.3%). Follow-up ranged from 0 to 11 y. CAR patency rates ranged from 44 to 100%. There was no substantial evidence supporting an association between CAL versus CAR and short-term neurologic outcomes. CONCLUSIONS: Studies evaluating outcomes after CAL versus CAR for VA-ECMO are heterogeneous with limited generalizability. Further studies are needed to evaluate long-term consequences of CAL versus CAR, especially as the first survivors of pediatric/neonatal ECMO approach an age of increased risk of carotid stenosis and stroke.

Carotid interposition in patients with head and neck tumors: clinical experience of 13 cases reconstructed with a great saphenous vein autograft.

BACKGROUND: Carotid interposition graft (CIG) surgery in the setting of head & neck cancer (HNC) is a rare procedure with a limited number of cases described in the literature. AIMS/OBJECTIVES: To assess the outcomes of the surgery at Helsinki University Hospital. MATERIALS AND METHODS: Patients who underwent CIG in a head and neck tumor surgery were retrospectively analyzed over 15 years. Overall-survival (OS) was calculated until 1 May 2020. The primary-outcome was to measure the 30-day OS, postoperative stroke rate, and other complications. The secondary-outcome was to measure 1-, 2-, and 5-year OS. RESULTS: Thirteen patients were identified, 11 with HNC and two with Shamblin III Carotid Body Tumors. The great saphenous vein was used for all vascular reconstructions, and shunting was routinely performed. The 30-day stroke incidence was nil. Two graft-blowouts were encountered, one of which lead to death and the other was successfully managed. For HNC patients, the locoregional recurrence-rate was 36%. The 5-year OS was 46.2%. CONCLUSION AND SIGNIFICANCE: CIG in HNC setting can achieve oncologic-control with an acceptable rate of complications. Routine shunting, heparinization, and elevating blood-pressure during closure seem to be safe protocols to maintain cerebral-circulation perioperatively. A moderate graft-blowout risk should be considered.

The Influence of Young Age on Difficulties in the Surgical Resection of Carotid Body Tumors.

This study evaluated patient characteristics that affect the complexity and difficulties of performing surgery to resect carotid body tumors (CBTs). We retrospectively reviewed the medical records of 20 patients with 21 CBTs who were enrolled in the study. The median patient age was 46 years and the mean tumor diameter was 37.6 mm. The mean blood loss and operative time were 40.3 mL and 183 min, respectively. Four patients underwent resection of the carotid artery followed by reconstruction. These four patients were between 18 to 23 years of age at the time of surgery. The mean blood loss and operative time in these patients were 166 mL and 394 min, respectively, which differed significantly from those of older patients. Therefore, young age influenced the difficulties faced in surgical resection of CBT, with an increased risk of blood loss and carotid artery resection.

Management and outcomes of vascular reconstruction in carotid body tumor resection: retrospective analysis of 60 cases.

PURPOSE: Carotid body tumors (CBTs) are rare tumors of the head and neck area. We evaluated outcomes after carotid body tumor resection (CBR) requiring vascular reconstruction. METHODS: We retrospectively reviewed the patients, who underwent CBR in our clinic. Medical records were retrospectively reviewed for clinical data, operative details, Shamblin's classification, complications. Comparisons were performed between those undergoing CBR alone and CBR requiring vascular reconstruction (CBR-VASC). RESULTS: Of the 60 patients, who underwent CBR, 29 (48.3%) underwent vascular reconstruction after the tumor resection. In patients; who underwent carotid endarterectomy and reconstruction of a kinked carotid artery, the blood flow measurements obtained before and after the vascular reconstruction were significantly different. The blood flow measurement parameters obtained before and after the vascular reconstruction were not significantly different in patients undergoing primary repair surgery, patch graft angioplasty, and the use of reversed saphenous vein graft procedures. The overall complication rate was 25% (n = 60) for at least one perioperative problem (CBR 6.4% vs. CBR-VASC 44.8%, p > 0.05). While most patients with Shamblin's class I and II tumors underwent CBR, CBR-VASC was performed more frequently in patients with Shamblin's class III tumors (p = 0.016). The tumor size ( p = 0.016), the volume of intraoperative blood loss (p = 0.002), and the length of hospital stay (p = 0.006) were significantly different between the two groups. The length of the operation time (p = 0.154) and the volume of the postoperative blood drainage (p = 0.122) were not different between the two groups. CONCLUSION: The decision for surgical reconstruction should be made by evaluating the carotid artery blood flow before and after CBR. The type of the reconstruction method does not cause differences in the duration of the surgery and does not elevate the complication rates.

Surgical management of carotid body tumor - Is Shamblin classification sufficient to predict surgical outcome?

Background The study aims to conduct a review of the surgical management of carotid body tumor. Methods Consecutive patients with CBT who received surgical interventions from January 1994 to January 2014 at our institution were reviewed. Clinical, operative, pathological and follow up information were reported. Results Twenty patients (four males; median age was 36) with 21 CBT operations were recorded during the period. One patient undertook sequential operations for bilateral CBTs. Patients had 19 neck mass, 1 incidental finding and 1 facial nerve palsy. Six CBTs (28.6%) were Shamblin class I, ten (47.6%) were class II and five (23.8%) were class III. Nine CBTs had preoperative conjunctive embolization. Two operations required internal carotid artery resection and reconstruction. Four patients received subtotal resections, while 17 achieved complete resection. Complications included two major strokes, three hoarse voice and two Horner's syndrome. Shamblin class was significant predictor of operative time, blood loss, and whether complete resection accomplished, but could not predict postoperative complication. With median follow up period of 94 months, there was no tumor recurrence found in those had complete resection. Conclusions This small cohort showed that Shamblin class was significant in predicting technical difficulties but could not predict occurrence of complications.

Evaluating the role of embolization and carotid artery sacrifice and reconstruction in the management of carotid body tumors.

OBJECTIVES/HYPOTHESIS: To review the surgical management of carotid body tumors (CBT), outcomes of carotid artery reconstruction, as well as utility of preoperative embolization. STUDY DESIGN: Retrospective chart review. METHODS: A single-surgeon case series with chart review was performed of all cases between 1997 and 2014 at a single institution. Tumor classification, major neurovascular resection, requirement for in-line carotid artery reconstruction, intraoperative blood loss, and operative time, and postoperative neurovascular complications were determined. RESULTS: In all, 96 patients with 101 CBTs underwent definitive resection disease. Vascular sacrifice was 2.9% (three) for the internal jugular vein, 8.9% (nine) for the external carotid artery, and 13.8% (14) for the internal carotid artery (ICA). ICA sacrifices were performed with immediate in-line arterial bypass grafting with vascular surgery. Permanent cranial neuropathies occurred in 4.9% (five) of patients, without cerebrovascular events. CONCLUSIONS: We recommend surgical resection as the primary approach to the management of these CBTs. In lesions involving the ICA, we recommend vein bypass grafting. We found no differences or advantages to preoperative embolization. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:2282-2287, 2016.

[Retrospective analysis of operative methods and complications in 29 patients with carotid body tumor].

Objective:To analyze the operative methods and complications for surgical resection of carotid body tumor (CBT). Method:Clinical data of 29 patients underwent CBT resection from Jan 2007 to Apr 2015 were retrospectively studied. Result:Five out of 29 patients got bilateral CBT, the others had unilateral lesions, totally 34 CBT resection were performed. Tumor completely dissected without carotid artery clamping and reconstruction in 18 procedures, tumor resection combined with external carotid artery resection in 16 procedures, 9 out of these 16 procedures combined with internal carotid artery resection. The internal carotid artery was reconstructed with autologous greater saphenous vein in 4 procedures, with artificial graft in 3 procedures, and internal carotid artery ligation without reconstruction in 2 procedures. There was no patient death during perioperative period, cerebral infarction happened in 1 patient and cranial nerve injury occurred in 12 cases. Conclusion:Carotid artery resection and reconstruction is very common during CBT resection, surgeon must be familiar with the methods of carotid artery reconstruction, and the most common complication of carotid body tumor resection is the cranial nerve injury.

A novel procedure for reconstruction utilizing superficial femoral vein grafts following en bloc resection of carotid artery and head and neck malignant tumours.

OBJECTIVES: The objective of our study was to investigate the effectiveness of reconstructing the carotid artery using a superficial femoral vein (SFV). METHODS: Ten patients with malignant tumours involving the carotid artery underwent carotid artery resection and reconstruction with the SFV. We use the SFV between the deep femoral vein and perforator branches to the great saphenous vein or deep femoral vein at the popliteal region reconstructive vessel. RESULTS: The mean length and diameter of the grafted SFVs were 13.9 and 11.2 mm, respectively. The mean time for SFV acquirement was 18 min. The mean cerebral ischaemic period was 23.1 min. Nine patients did not experience any neurological complications. One patient experienced slight temporary hemiparesis. There was no postoperative vascular graft thrombosis. Donor site complications did not occur. CONCLUSIONS: Reconstructing the carotid artery using an SFV is very effective due to the ease in harvesting the vessel and its optimal size and length for carotid artery replacement.