Recurrent carotid artery stenosis. Resection with autogenous vein replacement

Recurrent carotid artery stenosis (RCAS) occurs in 10% to 15% of patients following carotid endarterectomy (CEA). A recurrent stenosis may occur as early as 6 months and will become symptomatic in 3% to 5% of patients. Early stenosis is myointimal hyperplasia, but with the passage of time may progress to the characteristic atherosclerotic lesion. Improvements in noninvasive testing allows for evaluation and early detection of restenosis. Since 1974 we have performed 3711 CEAs in 2909 patients. One hundred and six second or third CEAs were performed in 98 patients (3.5%). In 20 of these reoperations, the common carotid (CCA) and internal carotid artery (ICA) were resected and replaced by autogenous vein, usually saphenous. One of these patients had 3 previous CEAs while 7 patients had 2 and 12 patients had 1 previous operation. There were no deaths; thrombosis of one vein interposition requiring replacement occurred. Hoarseness and hypoglossal nerve palsy occurred in one patient. Follow-up ranged to 5 years with a mean of 2.8 years. Although a second CEA is possible, there are inherent technical difficulties that may be encountered and vein interposition will solve these as well as offer the potential to prevent a further recurrence.