Abstract

Objectives: This study aims to investigate the possible relationship between low ankle-brachial index (ABI) and shunt requirement during
carotid endarterectomy (CEA) operations.
Patients and methods: Medical records of a total of 56 patients (40 males, 16 females; mean age: 65.6±8.4 years; range, 48 to 82 years) who
underwent CEA between January 2013 and December 2016 were retrospectively reviewed. The ABI was measured in all patients at the time
of hospital admission. Peripheral arterial disease was defined as having an ABI of ≤0.90 in either leg. Selective carotid artery shunt strategy
was applied to all patients who underwent CEA under regional anesthesia.
Results: Forty-eight (85.8%) patients were symptomatic. Peripheral arterial disease was diagnosed in 25 (44.6%) patients with ABI
measurements. Eleven (19.6%) patients required shunt placement due to neurological deterioration during the carotid clamping test.
The mean ABI of 11 (19.6%) patients was 0.8±0.15, while the ABI was less than 0.90 in 10 (17.8%) patients. There was a statistically
significant correlation between perioperative shunt usage and peripheral arterial disease (odds ratio [OR]: 19.68, 95% confidence
interval [CI]: 2.3-164.4; p=0.001).
Conclusion: Low ABI appears to be related to a higher rate of shunt requirement in patients undergoing CEA under regional anesthesia
with a selective shunt strategy in our modest cohort.

Key words: Ankle-brachial index, carotid artery shunting, carotid endarterectomy