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External Carotid Artery Preservation Improves Long-Term Outcomes after Carotid Graft Reconstruction
Srđan Babić1, Slobodan Pešić2, Aleksandra Milačić2
1Vascular Surgery Clinic, Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia; School of Medicine, Belgrade University, Belgrade, Serbia.
Background:
The role of external carotid artery (ECA) preservation during carotid graft interposition remains unclear. This study evaluated its impact on perioperative and long-term outcomes.
Methods:
A retrospective study included 161 patients undergoing carotid graft interposition. Patients were divided into ECA-preserved (n = 36) and ECA-ligated (n = 125) groups. Outcomes included perioperative events and long-term outcomes, including in-graft stenosis, reintervention, and stroke-free survival.
Results:
The mean follow-up was 30.28 ± 19.24 months (range, 1-66 months). In-graft stenosis occurred in 15 patients (9.4%), all in the ECA ligation group, while no in-graft stenosis was observed in the ECA preservation group (12.2% vs. 0%; log-rank P = 0.042). No significant differences were found in survival, myocardial infarction, cerebrovascular events, or reintervention. Composite adverse events were more frequent in the ECA ligation group (25.2% vs, 5.6%; P = 0.011). ECA ligation was an independent predictor of adverse outcomes (OR 5.459; P = 0.026).
Conclusion:
ECA preservation was associated with absence of restenosis and improved long-term outcomes without increasing perioperative risk.
