Die Entwicklung der operativen Desobliteration der Arteria carotis interna über den Zeitraum einer Dekade

In 1953 Dr. DeBakey and his team already performed the first operative desobliteration of a carotid artery. It is a fact that endarterectomy brings a great benefit to patients with carotid stenosis. However quite a bit changed since the invention of the carotid surgery. This dissertation shall give an overview of the developments in this field at the University Medical Center in Marburg and if these led to a medical progress. To clarify the issue, a retrospective observational study of 297 patients who were operated on at least one carotid artery in the period between January 2000 and December 2001 (period A) and between January 2010 and December 2011 (period B), respectively was performed. After a clear arrangement of the cohorts they were compared in regard to predefined criteria. Significant differences relating to the procedure were found. The time of operation was reduced from 119 minutes in period A to 100 minutes in period B. Furthermore, the median clamping time was lessened from 335 seconds (2000 - 2001) to 218 seconds (2010 - 2011). Also, a decrease in time of hospitalization of the patients was found. In 2000 and 2001 the median time to stay in the clinic amounted to twelve days overall and five days postoperatively. Ten years later, the length of stay was only six days overall and three days postoperatively. The fact that five times as much of the patients were asymptomatic to the time of procedure in period B shows the improved early detection of carotid stenosis. Neither lethality nor restenosis showed significant changes. In fact this has been predictable because of the low risk of procedure in the first place even ten years earlier. Besides the rate of strokes the rate of local and postoperative complications could be reduced. This led to a better overall outcome. In comparison to the corresponding data the results at the clinic in Marburg keep up with the international standards. To sum it up this dissertation shows a clear increase in medical progress in the University Medical Center in Marburg over one decade.