[Our experience with carotid restenoses. Value of digital angiography using the arterial approach]

Between January 1980 and December 1985, 721 operations on the internal carotid artery were performed in the Department of Vascular Surgery, Hôpital de la Timone, Marseilles. During this 6-year period, carotid artery restenosis was detected in eleven patients. All had been operated upon initially in the department: carotid thromboendarterectomy (10 cases), internal saphenous vein graft (1 case). All but one patient were asymptomatic at time of diagnosis of restenosis, the mean a period of which was 20.5 months. Identification was by cervical murmur (5 cases), routine review Doppler examination (2 cases), digital subtraction angiography by arterial approach (2 cases); this examination being conducted on contralateral carotid artery during preoperative investigations, and conventional arteriography of supra-aortic trunks to determine permeability of a contralateral temporo-sylvian anastomosis in one patient. Digital subtraction angiography by the arterial approach was carried out in 8 of the 11 patients. Apart from the simplicity of repeated examinations (16 times in these 8 patients) this procedure permitted medical treatment to be instituted for 2 cases of restenosis and was sufficient to indicate the need for 5 repeat operations. A total of 6 recovery operations were performed, one in a symptomatic patient and five in asymptomatic patients: rapid surgery was necessary in 4 of these because of an immediate critical restenosis. Surgery was carried out in the last case due to progressive worsening of repeated stenotic lesions on serial angiographic examinations. Operations included venous grafts (crural internal saphenous vein) in 4 cases and angioplasty with venous patch grafts in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)