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Early and late geometric changes after carotid endarterectomy patch reconstruction
1Wake Medical Center, Raleigh, North Carolina.
Insights
Carotid endarterectomy with vein patch reconstruction leads to mild internal carotid artery dilation and common restenosis. These changes are generally not severe and do not cause aneurysms or occlusions.
Area of Science:
- Vascular Surgery
- Vascular Imaging
- Cardiovascular Research
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Patch angioplasty is frequently used for reconstruction after carotid endarterectomy.
- Long-term geometric changes after patch reconstruction require further investigation.
Purpose of the Study:
- To assess the degree and location of vessel wall geometric changes after carotid endarterectomy with vein patch reconstruction.
- To evaluate changes in carotid artery diameters and identify restenosis development.
- To determine the incidence of aneurysms or occlusions post-procedure.
Main Methods:
- Intraoperative caliper measurements of carotid artery diameters in 349 patients.
- Postoperative B-mode ultrasound studies with cross-sectional views.
- Follow-up measurements from 3 months to 5 years after surgery.
- Analysis of vein patch, synthetic patch, and primary closure reconstructions.
Main Results:
- Internal carotid artery diameters increased by 20-30% after vein or synthetic patch reconstruction.
- This dilation was observed early and progressed slightly over 5 years.
- Wall thickening and mild eccentric stenosis (<50%) were common, primarily on the posterior-medial wall.
- No aneurysms or internal carotid occlusions were identified.
Conclusions:
- Carotid endarterectomy with vein patch reconstruction results in early, mild internal carotid artery dilation.
- Frequent mild eccentric restenosis occurs, but significant concentric restenosis is rare.
- The observed changes are generally non-aneurysmal and do not lead to occlusion.
Abstract:
This study examines the degree and location of vessel wall geometric changes after carotid endarterectomy-vein patch reconstruction. The external diameters of the proximal common carotid, common carotid bulb, and internal carotid arteries were measured during operation with a caliper after 349 carotid endarterectomies. There were 309 saphenous vein reconstructions, 31 synthetic patch reconstructions, and 9 primary closures. One or more B-mode ultrasound studies with cross-sectional views for common and internal carotid cursor measurements were performed from 3 months to 5 years after operation. The intraoperative-to-postoperative common carotid diameters were unchanged for the three types of reconstructions. The internal carotid diameters increased 20% to 30% for both the vein and synthetic patched arteries. This dilation was present at 3 and 6 months and progressed slightly over 5 years. Wall thickening greater than or equal to 1 mm was present in 62% of the carotid endarterectomies, with concentric stenosis in 3% and eccentric stenosis in 59%. Eccentric stenosis was present at 3 to 6 months, located on the endarterectomized posterior-medial wall of the common and internal carotid arteries, was always less than 50%, and changed very little over 5 years. No aneurysms or internal carotid occlusions were identified. Carotid endarterectomy-vein patch reconstruction results in early, mild, nonaneurysmal dilation of the internal carotid patched segment, frequent mild eccentric restenosis, and rare hemodynamically significant concentric restenosis.