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Benefits of carotid patching: a randomized study
B C Eikelboom1, R G Ackerstaff, H Hoeneveld
1Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Journal of Vascular Surgery
|February 1, 1988
Summary
Carotid artery patching significantly reduces recurrent stenosis after endarterectomy compared to primary closure, especially in women. This prospective study highlights patching as a superior technique for long-term carotid artery health.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Surgical Outcomes
Background:
- Recurrent stenosis after carotid endarterectomy is a clinical concern.
- Carotid artery patching is advocated to reduce this complication.
- Primary closure is an alternative surgical technique.
Purpose of the Study:
- To prospectively evaluate the efficacy of saphenous vein patching versus primary closure in preventing recurrent stenosis after carotid endarterectomy.
- To compare the rates of restenosis between the two surgical techniques.
Main Methods:
- A prospective study of 129 carotid endarterectomies with random selection for primary closure (62 patients) or saphenous vein patching (67 patients).
- Duplex scanning at 3, 6, and 12 months post-operation.
- Intravenous digital subtraction angiography (DSA) for initial control and 1-year reference.
Main Results:
- 1-year follow-up in 105 patients (81%).
- Overall recurrent stenosis (>50%) was 11% (12 cases).
- Significantly higher restenosis after primary closure (21%) vs. patching (3.5%; p=0.006).
- Higher restenosis in women (24%) vs. men (7.5%; p=0.03).
- Women undergoing primary closure had the highest restenosis rate (55%).
Conclusions:
- Saphenous vein patching is superior to primary closure in reducing recurrent stenosis after carotid endarterectomy.
- Women represent a higher-risk group for recurrent stenosis, particularly with primary closure.
- Patching should be considered to improve long-term outcomes in carotid endarterectomy patients.