Recurrent carotid stenosis after autologous tissue patching

This study was carried out to evaluate two techniques of widening the carotid bifurcation with autologous material after endarterectomy to determine whether the incidence of recurrent stenosis could be reduced. As a control, a similar series was performed without patching. Autologous saphenous vein was used as a patch in one group of patients, whereas in another, the bifurcation was widened by suturing the external carotid to the internal carotid artery, advancing the bifurcation by several centimeters, a technique we termed bifurcation advancement. All three groups were studied at least 1 year after operation by means of Doppler ultrasonography. We found no difference in either of the patched techniques compared with unpatched controls. Significant recurrent stenosis (greater than 50% diameter reduction) was found in 12.5% of reconstructions with a vein patch, 12.5% of those with bifurcation advancement, and 16.6% of those with simple closure. The overall incidence of significant recurrent stenosis was 13.8%, with symptoms occurring in 2.7%.