Intraoperative use of dextran is associated with cardiac complications after carotid endarterectomy

Alik Farber, Tze Woei Tan, Denis Rybin, Jeffrey A. Kalish, Naomi M. Hamburg, Gheorghe Doros, Philip P. Goodney, Jack L. Cronenwett

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective: Although dextran has been theorized to diminish the risk of stroke associated with carotid endarterectomy (CEA), variation exists in its use. We evaluated outcomes of dextran use in patients undergoing CEA to clarify its utility. Methods: We studied all primary CEAs performed by 89 surgeons within the Vascular Study Group of New England database (2003-2010). Patients were stratified by intraoperative dextran use. Outcomes included perioperative death, stroke, myocardial infarction (MI), and congestive heart failure (CHF). Group and propensity score matching was performed for risk-adjusted comparisons, and multivariable logistic and gamma regressions were used to examine associations between dextran use and outcomes. Results: There were 6641 CEAs performed, with dextran used in 334 procedures (5%). Dextran-treated and untreated patients were similar in age (70 years) and symptomatic status (25%). Clinical differences between the cohorts were eliminated by statistical adjustment. In crude, group-matched, and propensity-matched analyses, the stroke/death rate was similar for the two cohorts (1.2%). Dextran-treated patients were more likely to suffer postoperative MI (crude: 2.4% vs 1.0%; P =.03; group-matched: 2.4% vs 0.6%; P =.01; propensity-matched: 2.4% vs 0.5%; P =.003) and CHF (2.1% vs 0.6%; P =.01; 2.1% vs 0.5%; P =.01; 2.1% vs 0.2%; P <.001). In multivariable analysis of the crude sample, dextran was associated with a higher risk of postoperative MI (odds ratio, 3.52; 95% confidence interval, 1.62-7.64) and CHF (odds ratio, 5.71; 95% confidence interval, 2.35-13.89). Conclusions: Dextran use was not associated with lower perioperative stroke but was associated with higher rates of MI and CHF. Taken together, our findings suggest limited clinical utility for routine use of intraoperative dextran during CEA.

Original languageEnglish (US)
Pages (from-to)635-641
Number of pages7
JournalJournal of vascular surgery
Volume57
Issue number3
DOIs
StatePublished - Mar 2013
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Intraoperative use of dextran is associated with cardiac complications after carotid endarterectomy'. Together they form a unique fingerprint.

Cite this