Carotid bifurcationplasty: an alternative to patching

Patching of carotid endarterectomies has been advocated as a means of both facilitating secure closure and minimizing recurrent stenosis. Most vascular surgeons occasionally, if not always, patch selected carotid arteries. However, patching requires the surgeon to utilize either prosthetic material (Dacron or PTFE), which is relatively thrombogenic, or autogenous vein, which requires a second operative field and available saphenous vein at the ankle. Bifurcationplasty, otherwise known as bifurcation advancement, has been used as an alternative to patching at our institution over the past four years. This technique, which involves the use of the opened, endarterectomized external carotid artery as an autogenous in-continuity patch for the internal carotid artery, obviates the need for prosthetic materials and saphenous vein alike. This procedure has been performed 30 times over a 4-year period (1987-91). During this time, 280 carotid endarterectomies were performed. A vein patch or Dacron was used in four cases early in this series. Bifurcationplasty was also the procedure of choice for repeat carotid endarterectomy, and was performed in five cases of recurrent stenosis after direct closure. In a follow-up period averaging 22 months (range 1-48), there were no instances of symptomatic restenosis. We feel that bifurcationplasty is an easily performed autogenous alternative to conventional patch closure of the carotid artery.