5. Vascular Surgery

Background:The European Society of Vascular Surgery (ESVS) has published quality standards in its guidelines for Carotid Endarterectomy.The perioperative mortality and stroke rate should be below 3% for asymptomatic and below 6% for symptomatic patients.The objective of this study was to verify whether these thresholds could be maintained.Furthermore, the rate and the underlying reasons for reoperations were to be determined. Material and methods:Included were all patients who underwent surgery at the University Hospital Graz within the period from January 1 st , 2014, to December 31 st , 2023.A retrospective data collection was performed.To execute this analysis, all CT and MRI data, reoperations, and deaths within 30 days from the KAGES hospitals across the entire region of Styria were collected and evaluated with the help of the IT department. Results:A total of 2500 patients were evaluated, with an average age of 71.3 years.Gender distribution showed 67.6% (1689/2500) men and 32.4% (811/2500) women; 76.6% (1916/2500) were asymptomatic, while 23.4% (584/2500) were symptomatic.Sinus rhythm was present in 92.0%(2301/2500), with (intermittent) Atrial Fibrillation/Flutter (VHFA) in 7.9% (197/2500).Postoperatively, 2.3% (45/1871) of asymptomatic patients and 2.6% (15/569) of symptomatic patients required at least one reoperation.The causes were: 76.7% (46/60) bleeding, 21.7% (13/60) incorrect revascularization, and 1.7% (1/60) deep abscess.A total of 14 deaths occurred within 30 days: 0.5% (10/1906) for asymptomatic patients and 0.7% (4/580) for symptomatic patients.The stroke rate was 1.7% (32/1884) for asymptomatic patients and 4.8% (28/556) for symptomatic patients.The combined endpoint (stroke and death) occurred in 2.9% (73/2500) of patients.The risk for symptomatic patients was 5.5% (32/552), significantly higher than for asymptomatic patients at 2.1% (41/1875). Conclusion:The analysis confirms that the ESVS standards were achieved at the University Hospital Graz.There are ongoing discussions within the ESVS about whether the quality thresholds for carotid surgery should be lowered.Our data advocate for maintaining the established standards.