How Useful Is Patch Angioplasty in Carotid Endarterectomy?

Palkovic, S; Fischer, Bernhard; Wassmann, H.

doi:10.1258/rsmvasc.12.3.206

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…The use of patch angioplasty has been suggested to improve hemodynamic flow in the artery by increasing the carotid artery diameter. 3,4 However, this positive influence of patch closure on the hemodynamic profile has been under discussion and recent studies question the routine use of patch angioplasty. Harrison et al found no favorable flow dynamics after patching, since incorporation of a patch increases areas of low wall shear stress and high oscillatory shear index at the bifurcation.…”

Section: Introductionmentioning

confidence: 99%

Complication Rate After Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure: Long-Term Outcome

Donder,

Maerens,

Maertens

et al. 2023

MRAJ

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Objective: In patients with symptomatic or asymptomatic severe internal carotid artery stenosis, carotid endarterectomy (CEA) has been shown to reduce risk for stroke. The optimal surgical technique remains subject of debate. In the latest European Society of Vascular Surgery (ESVS) guidelines on the management of atherosclerotic carotid disease, routine patching is preferred to routine primary closure. However, there are no RCT’s evaluating selective patching strategies. This follow-up study aimed to assess long term complication rate and restenosis after carotid endarterectomy with selective patching. Methods: Two hundred thirteen consecutive carotid endarterectomies over a 3-year period from January 5th 2011 to December 19th 2013 were prospectively analyzed in a follow-up study over 5 years (mean 4.6, range 3.17-6.17). Patient population consisted of 141 procedures on males and 72 on females with mean age 73 years at the time of surgery (standard deviation (SD) 8.57, range 53-95). There was a follow-up of 89%. Postoperative risk factors were assessed such as hypertension, diabetes mellitus, coronary artery disease and smoking. Postoperative symptoms of cranial nerve injury, transient ischemic events, cerebrovascular events and mortality were evaluated. Duplex ultrasound was performed by a radiologist blinded to the operative technique to evaluate patency of the carotid artery after carotid endarterectomy. Results: Primary closure was used in 110 operations, and patch angioplasty in 103 procedures (Dacron patch). Primary closure was performed when the carotid artery had a diameter above 5 mm, when there was a high carotid bifurcation or when the contralateral carotid artery was occluded. There were no significant differences among groups' baseline characteristics at the time of surgery. Primary closure was performed significantly more in male patients (P= .02). Overall complication rate was 3.76% postoperatively (1.8% after primary closure, 5.8% after patch angioplasty) and after 5 years 5.29% (2.0% after primary closure, 9.1% after patch angioplasty). There are no significant differences in results between the two groups (P= .09 and P= .05). In four cases patients experienced symptoms of cranial nerve damage postoperatively, two in each group. In one of the two cases in each group, the patient fully recovered and the other had persistent complaints (P-value= 1). None of the patients experienced amaurosis fugax during the 5-year follow up period. In five cases a patient had an ipsilateral cerebrovascular thrombosis in the group after patch angioplasty compared to zero in the primary closure group (P-value= .02). In the group of primary closure there was a mortality of 26 patients (23.6%) compared to 26 (25.2%) patients after patch angioplasty (P-value = .70). One was caused by cerebral hyperperfusion syndrome within one month postoperative after patch angioplasty and none were caused by an ipsilateral ischemic stroke. Objective duplex ultrasound showed no significant difference comparing restenosis in both groups (P-value= .43). In twelve cases patients showed a restenosis between 50-70% (6 primary closure and 6 patch angioplasty), none of the patients had high grade restenosis of more than 70%. Patient characteristics did not show a significant effect on long term outcomes. There was a correlation between postoperative use of antihypertensive medication and long-term stroke (P-value= .006), restenosis (P-value= .01) and mortality (P-value= .003). Conclusion: After long-term follow-up we found primary closure and patch angioplasty to be equivalent with respect to complication rate and restenosis when used in selected cases. Best medical treatment and especially the use of antihypertensive medication should be emphasized.

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Section: Introductionmentioning

confidence: 99%

Complication Rate After Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure: Long-Term Outcome

Donder,

Maerens,

Maertens

et al. 2023

MRAJ

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“…1) even imposed with infection after patch angioplasty [3] occur as twice as often as after primary closure [4]. Moreover the risk of infection or even prion transmission using different biological patch material cannot be entirely neglected [5]. Whatever procedure inside of primary patch angioplasty later on can be technically more demanding [6] or troublesome, as well.…”

Section: Introductionmentioning

confidence: 99%

Threatening of cerebrovascular insufficiency within surgery of carotid artery restenosis

et al. 2007

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AbstractSurgical intervention for extracranial carotid artery stenosis remains a major potential therapeutic modality for the prevention of stroke. Nevertheless, every kind of surgical technique for carotid entarterectomy (CEA) has its specific complications, compromising the final surgical result. The authors report about a 70-year old man, suffering from recurrent transient ischemic attacks by suspected internal carotid artery (ICA) re-stenosis, 11 and 13 years after CEA with patch angioplasty. In relation to neurological symptomatic and angiographic appearance of ICA re-stenosis an open surgery of the left ICA was preferred. Intraoperatively the old patch material was such vulnerable that it was not possible to maintain the continuity of ECA and ICA or CCA and ICA. Consequently reconstruction and replacement of ICA and ECA with 6 mm Gore-Tex grafts was performed. Follow-up three years after surgery showed no symptoms of insufficient brain metabolism as well as a good flow within the grafts. Patch angioplasty by CEA seems to be favourable to reduce the risk of early ICA re-stenosis but for all that there are other accompanying problems, which can compromise utility of patch technique. For this the authors prefer a patient adapted surgical treatment, based not only on so far not significant data but moreover on personal experience.

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Complication Rate after Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure

Maertens

Kint

et al. 2016

Annals of Vascular Surgery

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How Useful Is Patch Angioplasty in Carotid Endarterectomy?

Cited by 3 publications

References 6 publications

Complication Rate After Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure: Long-Term Outcome

Complication Rate After Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure: Long-Term Outcome

Threatening of cerebrovascular insufficiency within surgery of carotid artery restenosis

Complication Rate after Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure

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