Common facial vein: an alternative patch material in carotid angioplasty

Patch angioplasty is a popular adjunct to carotid endarterectomy to facilitate arteriotomy closure. The long saphenous vein is the common autogenous patch in use. We tested the feasibility of using the ipsilateral common facial vein (CFV), which is usually sacrificed during exposure of the carotid bifurcation. A consecutive series of 17 patients undergoing carotid endarterectomy was examined to show the use of CFV patch in arteriotomy closure in 18 procedures. During exposure of the carotid bifurcation, the facial vein was harvested and distended with heparinized saline to assess the size of the vein. If the vein had an adequate diameter, it was everted and used as a double-layered patch. Patients were followed up postoperatively with serial duplex scanning at 3, 6 and 12 months, and yearly thereafter. The median (range) age of the patients in the series was 66 years (52-72 years). Of the 18 CFV harvested, 2 were rejected because of small calibre. The median (range) length of the vein harvested was 5 cm (4-6 cm). The average diameter of harvested vein was 5 mm. The median (range) time taken for harvesting, distending and everting the vein was 10 min (8-12 min). There were no perioperative deaths or strokes. There was no significant re-stenosis during the follow up of 24 months (18-36 months), with a mean peak velocity of 0.86 m/s (0.58-1.29 ). The use of everted CFV patch in carotid angioplasty is safe, quick, convenient and durable, whereas saphenous veins are spared and lower limb incisions avoided.