Carotid endarterectomy with a polyurethane patch versus primary closure: A prospective randomized study

Mannheim, Dallit; Weller, Boaz; Vahadim, Eran; Karmeli, Ron

doi:10.1016/j.jvs.2004.11.036

Cited by 72 publications

(54 citation statements)

References 26 publications

(27 reference statements)

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“…Lastly, the surgical patch angioplasty method may limit restenosis after drug delivery is reduced below therapeutic levels, e.g. after the drug is exhausted, since the patched site has less tendency for form restenosis, thereby increasing the translational potential of patch angioplasty30313233.…”

Section: Discussionmentioning

confidence: 99%

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Bai

Lee

Chen

et al. 2017

Sci Rep

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Prosthetic grafts and patches are commonly used in cardiovascular surgery, however neointimal hyperplasia remains a significant concern, especially under low flow conditions. We hypothesized that delivery of rapamycin from nanoparticles (NP) covalently attached to patches allows sustained site-specific delivery of therapeutic agents targeted to inhibit localized neointimal hyperplasia. NP were covalently linked to pericardial patches using EDC/NHS chemistry and could deliver at least 360 ng rapamycin per patch without detectable rapamycin in serum; nanoparticles were detectable in the liver, kidney and spleen but no other sites within 24 hours. In a rat venous patch angioplasty model, control patches developed robust neointimal hyperplasia on the patch luminal surface characterized by Eph-B4-positive endothelium and underlying SMC and infiltrating cells such as macrophages and leukocytes. Patches delivering rapamycin developed less neointimal hyperplasia, less smooth muscle cell proliferation, and had fewer infiltrating cells but retained endothelialization. NP covalently linked to pericardial patches are a novel composite delivery system that allows sustained site-specific delivery of therapeutics; NP delivering rapamycin inhibit patch neointimal hyperplasia. NP linked to patches may represent a next generation of tissue engineered cardiovascular implants.

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Section: Discussionmentioning

confidence: 99%

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Bai

Lee

Chen

et al. 2017

Sci Rep

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“…Selection of patch material is affected by thrombogenicity, aneurismal formation, risk of patch rupture, availability of patch material, complications related to vein harvesting, and the resistance to infection. Some surgeons prefer harvesting autologous veins, including the saphenous vein, or the internal/external jugular vein and facial vein [8]. RCTs and animal studies support that using an intima-lined patch may potentially reduce the risk of perioperative thrombosis and infection [26].…”

Section: Discussionmentioning

confidence: 99%

“…A variety of patch materials for closure of the arteriotomy are available, including autologous venous patch and synthetic patch materials (Dacron, polytetrafluoroethelene (PTFE), bovine pericardium, and polyester urethane) [4]–[8]. Currently, selection of types of patch materials depends on the surgeon’s preference, as there is no agreement on the priority of use of venous over synthetic patch materials during CEA [1].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Randomized Controlled Trials of Different Types of Patch Materials during Carotid Endarterectomy

Ren

Wen

et al. 2013

PLoS ONE

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Background and PurposeCarotid endarterectomy (CEA) with patch angioplasty produces greater results than with primary closure; however, there remains uncertainty on the optimal patch material in CEA. A systematic review of randomized controlled trials (RCTs) was performed to evaluate the effect of angioplasty using venous patch versus synthetic patch material, and Dacron patch versus polytetrafluoroethelene (PTFE) patch material during CEA.MethodsA multiple electronic health database screening was performed including the Cochrane library, Pubmed, Ovid, EMBASE and Google Scholar on all randomized controlled trials (RCTs) published before November 2012 that compared the outcomes of patients undergoing CEA with venous patch versus synthetic patch. RCTs were included if they compared carotid patch angioplasty with autologus venous patch versus synthetic patch material, or compared one type of synthetic patch with another.ResultsThirteen RCTs were identified. Ten trials, involving 1946 CEAs, compared venous patch with synthetic patch materials. Two trials, involving 400 CEAs in 380 patients, compared Dacron patch with PTFE patch. The hemostasis time in CEA with PTFE patch was significantly longer than with venous patch (P<0.0001), and longer than with Dacron patch (P<0.0001). There was no significant difference of mortality rate, stroke rate, restenosis, and operative time in CEA with venous patch versus synthetic patch material, or in CEA with Dacron patch versus PTFE patch (all P>0.05). One RCT of 95 CEAs in 92 patients compared bovine pericardium with Dacron patch, and demonstrated a statistically significant decrease in intraoperative suture line bleeding with bovine pericardium compared with Dacron patch (P<0.001).ConclusionsThe hemostasis time in CEA with PTFE patch was longer than with venous patch or Dacron patch. The overall perioperative and long-term mortality rate, stroke rate, restenosis, and operative time were similar when using venous patch versus synthetic patch material or Dacron patch versus PTFE patch material during CEA. More data are required to clarify differences between different patch materials.

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“…The exclusion of such patients, likely to be predominantly female, may therefore confound the results. Indeed, one study in the meta-analysis showed female patients to be at a significantly higher risk of restenosis 14 . Our study found that female sex was considered an indication for selective patching by a proportion of surgeons.…”

Section: Discussionmentioning

confidence: 47%

Patch variability following carotid endarterectomy: a survey of Great Britain and Ireland

Harrison

Brennan²,

Naik³

et al. 2012

Ann R Coll Surg Engl

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INTRODUCTIONEvidence suggests a clinical benefit with patch angioplasty after carotid endarterectomy (CEA). The UK National Vascular Database has demonstrated variation in practice but does not record technical details. This study was intended to define indications and technique of patching after CEA.METHODSAn electronic questionnaire was emailed to all 402 members of the Vascular Society of Great Britain and Ireland. The email could not be received by 23 and 14 did not perform CEA. Some questions allowed multiple answers. Fisher’s exact test was used for statistical analysis.RESULTSThere were 187 responses (51%). Fifteen members (8%) performed eversion CEA, which obviates patching. Of all the respondents, 121 surgeons (65%) always use a patch. Seventy of these (58%) use the full patch width (median: 8mm, range: 4–10mm). Fourteen (12%) variably trimmed the patch (median: 7.5mm, range: 5–10mm) and 34 (28%) routinely trimmed (median: 6mm, range: 3–20mm). Selective patching, dependent on internal carotid artery diameter, was performed by 48 respondents (26%), 23 of whom specified a median artery threshold diameter of 5mm (range: 3–8mm). General anaesthesia was always or usually used by 83 surgeons (45%), local anaesthesia by 77 (41%) and the remainder followed patient choice. Obligatory patching is performed by 68 of the 83 respondents (82%) who prefer general anaesthesia whereas only 40 of the 77 surgeons (52%) who use local anaesthesia always patch (p<0.0001).CONCLUSIONSThere is a variable rate of patching after CEA in the UK, which appears dependent on the vessel size and mode of anaesthesia. There are also differences in the patch width adopted.

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Carotid endarterectomy with a polyurethane patch versus primary closure: A prospective randomized study

Abstract: Patch angioplasty with polyester urethane significantly reduced the restenosis rate ( P = . 01) compared with primary closure. Even though clamping time was longer, patching was not associated with more perioperative complications.

Cited by 72 publications

References 26 publications

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Systematic Review of Randomized Controlled Trials of Different Types of Patch Materials during Carotid Endarterectomy

Patch variability following carotid endarterectomy: a survey of Great Britain and Ireland

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