Prevention of early restenosis and thrombosis-occlusion after carotid endarterectomy by saphenous vein patch angioplasty.

Abstract

The hypothesis that saphenous vein patch angioplasty protects against early postoperative restenosis and thrombosis-occlusion was tested by comparing the clinical outcome and carotid artery status of 100 carotid endarterectomies with and 100 without saphenous vein patch angioplasty performed by a single surgeon over a 30-month period. The patient population, selection, perioperative management, and the technical aspects of the operation, except for the vein patch, were essentially identical in both groups. Carotid artery status was assessed by direct continuous wave Doppler and Gee OPG at three to six months and again at one year postoperatively. There were two hospital deaths, both in the nonpatched group, one cardiac and the other neurologic due to internal carotid thrombosis. Two reversible neurological deficits due to thrombosis and one due to restenosis occurred in the non-patched group. Asymptomatic greater than 50% diameter restenosis occurred in four and asymptomatic occlusion in one non-patched carotids. There were no restenosis, no occlusions and no neurologic symptoms in the patched group. Morbidity, mortality, restenosis or thrombosis-occlusion occurred in 10/100 (10%) non-patched and 0/100 (0%) patched arteries (p less than 0.01 by Chi Square). Restenosis or thrombosis-occlusion occurred in 9/100 (9%) of non-patched and 0/100 (0%) patched arteries (p less than 0.01). These results support the use of saphenous vein patch angioplasty reconstruction of carotid endarterectomy to protect against early restenosis and thrombosis-occlusion.