Reinforced double-layer vein patch angioplasty in carotid endarterectomy to mitigate patch aneurysm

Carotid endarterectomy with patch angioplasty is standard for symptomatic carotid stenosis. However, prosthetic patches carry a risk of infection, particularly in patients with recent endocarditis. We report the case of a 67-year-old man who presented with central retinal artery occlusion and active mitral valve vegetation and subsequently underwent left carotid endarterectomy using a dual-layer facial vein patch. The harvested facial vein was everted to create a reinforced, double-layered conduit that was used for patch angioplasty, thereby avoiding prosthetic material. The patient awoke neurologically intact and 1-month duplex ultrasound demonstrated no residual stenosis or aneurysmal degeneration. Dual-layer everted cervical vein patches may provide a safe and durable autologous option in high-risk infectious settings.