What are the risk factors for hematoma formation following carotid endarterectomy (CEA)?

Updated: Oct 24, 2019
  • Author: Sonia Nhieu, MD; Chief Editor: Sheela Pai Cole, MD  more...
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Meticulous hemostasis during closure of the wound after CEA is the most important factor in reducing the incidence of hematoma formation. [2] Besides inadequate hemostasis, risk factors associated with hematoma formation include the following [15] :

  • Nonreversal of heparin
  • Intraoperative hypotension
  • Use of general anesthesia
  • Perioperative statin use
  • Use of a shunt

Hematoma formation, along with postoperative edema of the airway structures, makes airway management especially challenging in this emergency situation. Even in the absence of a hematoma formation, CT studies have shown that patients have increased airway edema, reducing the transverse airway diameter by as much as 75% in the postoperative period. [16]

In a 10-year retrospective analysis from the Mayo Clinic College of Medicine that included 3245 patients who underwent CEA, Shakespeare et al found that the average interval between completion of the CEA and return to the OR for neck exploration was 6.0 ± 6.0 hours. [17]  Of the 3245 subjects, 44 (1.4%) required a return trip to the OR for neck exploration and hematoma evacuation; three of the 44 required surgical decompression to secure the airway, and one required an awake tracheostomy after a failed awake direct laryngoscopy.

In a time-sensitive critical situation where there is impending respiratory compromise or airway loss, opening of the surgical incision to decompress the trachea and facilitate airway management should always be considered.

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