Author(s): Golledge J, Cuming R, Davies AH, Greenhalgh RM
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Abstract OBJECTIVES: Routine patch angioplasty has been advocated following carotid endarterectomy but patching can be associated with complications. This study assesses the effect of a selective patching policy based on distal internal carotid diameter on the rate of restenosis and outcome following carotid endarterectomy. DESIGN, MATERIAL AND METHODS: A consecutive series of 213 patients underwent carotid endarterectomy performed by one surgeon. Preoperative carotid dimensions were measured intraoperatively using calipers. Following endarterectomy a 5mm Dacron patch was selectively employed if the distal internal carotid was 5mm or less (group 1, 95 patients) or 6mm or less (group 2, 118 patients). Patients underwent colour-coded Duplex scanning at 24 h, 1 week, 3, 6, 9, and 12 months, and yearly following this. RESULTS: Overall 27 restenoses (5 residual) of 50\% or greater and two occlusions developed. Patching was performed in 47\% of group 1 and 61\% of group 2 arteries. In group 1 14\% of patched compared with 24\% of non-patched arteries developed restenosis at 24 months (p=0.4). In group 2 13\% of patched compared to 11\% of non-patched arteries developed restenosis at 12 months (p>0.5). Stroke rate at 24 months were similar for patched and non-patched patients in groups 1 (p>0.5) and 2 (p=0.4). CONCLUSIONS: This study suggests that patch angioplasty of larger carotid arteries may be unnecessary. Randomisation of larger arteries between patch and primary closure would be required to confirm this.
This article was published in Eur J Vasc Endovasc Surg
and referenced in Journal of Antivirals & Antiretrovirals