Comparison of saphenous vein patch, polytetrafluoroethylene patch, and direct arteriotomy closure after carotid endarterectomy. Part I. Perioperative results

Abstract

To evaluate the perioperative outcomes and the immediate increases in size after patch closure, 140 carotid endarterectomies were randomized into one of three groups: direct no-patch closure, saphenous vein patch closure, and polytetrafluoroethylene patch closure. Seven patients (4.4%) experienced signs of cerebral ischemia in the immediate postoperative period. In three cases this was transient and reversible. In the other four reexploration was undertaken and carotid thrombosis was corrected by thrombectomy. The condition of one of these patients deteriorated to a permanent stroke, whereas the other patients made a complete recovery. Neurologic complications were more frequent in the no-patch group, but the differences between the groups were not significant. The incidence of perioperative internal carotid stenosis, aneurysmal dilatation, and other morphologic abnormalities was assessed in 131 intravenous digital subtraction angiograms taken before the patient was discharged from the hospital. Eight (17.0%) of the endarterectomies in the no-patch group were narrowed by 30% to 50% diameter stenosis, whereas none of the patched arteries had more than 30% stenosis. In contrast, dilatation of the common or internal carotid artery to more than twice the measured diameter was absent in non-patched arteries but was present in seven (17.0%) saphenous patch closures and four (9.23%) polytetrafluoroethylene patch closures. We conclude that patch closure after carotid endarterectomy is less likely to cause stenosis in the perioperative period. Poly-tetrafluoroethylene patches resist dilatation better than do saphenous vein patches and are less likely to become aneurysmal.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

“…407,440,468,624,625,628 -630 When periodic duplex scanning is used, hemodynamically significant recurrent stenosis rates of 5% to 7% have been reported in multicenter trials in which the quality of surgery is monitored carefully. 396,403,404,406,440,628,[631][632][633][634][635][636][637][638][639][640][641][642][643][644][645] Recurrent carotid stenosis after CEA is a trimodal phenomenon. The first event is not really recurrence but instead represents an unsatisfactory or incomplete CEA.…”

Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study

“…No clinical experience with any of these agents has been reported. Expanded polytetrafluoroethylene, a biocompatible material, has been used safely and effectively for many years in multiple clinical applications in several surgical areas, including vascular surgery [19,22,27], soft-tissue repair [3], plastic surgery [23], gynaecology [5], cardiac surgery [14] and neurosurgery [13,33]. In long-term follow-up on patients in whom an ePTFE membrane [3,10,27,33] was implanted, the presence of wear debris was not shown; similarly, the implantation of this membrane in the defect of a rachidial laminectomy is not submitted to the same shear forces that prosthetic articular implants are.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…63,176,[276][277][278][279][280][281] Hemodynamically significant recurrent stenosis rates of 5% to 7% have been reported in multicenter trials. 62,176,276,[282][283][284][285][286][287][288][289][290][291][292][293][294][295][296][297][298][299] Data comparing restenosis after CEA and CAS must be interpreted cautiously because of selection bias and stent-generated artifacts in ultrasound velocity measurements. After 1 year of followup in the SPACE trial, 4.6% of patients who underwent CEA and 10.7% of those undergoing CAS had developed 70% recurrent stenosis as assessed by ultrasound (p50.0009).…”