External Jugular Everted Vein Patch Versus Synthetic Patch during Carotid Endarterectomy, Long-Term Results

Several interventions have been developed for carotid artery plaque-related ischemic stroke risk reduction; carotid endarterectomy (CEA) remained the gold standard. If longitudinal arteriotomy was used, patch angioplasty is recommended for closure. Different types of synthetic and autologous venous patches are in use for the purpose. The aim of this study was to compare the early and long-term outcome between autologous everted, hence double layer, external jugular vein (DL-EJVP), and Dacron patches (DPs).

Retrospective cohort comparison design identified patients who underwent CEA between 2006 and 2023. Two cohorts were built based on patch type: DL-EJVP and DP closures were included. Primary closure, shortening with resection, or posterior plication, other types of patches, and eversion endarterectomies were excluded. Demographics, relevant conditions, shunt use, utilization of intraoperative imaging were collected. Short- and long-term outcome measures included need for re-exploration, postoperative ischemic event, nerve injury, wound problems, length of stay, perioperative death, significant restenosis, pseudoaneurysm development, recurrent ipsilateral ischemic stroke, need for reintervention, and long-term survival.

In total, 134 CEA (34 DL-EJVP, 100 DP) met inclusion criteria. The cohorts were comparable in demographics and CEA-relevant conditions. More DL-EJVP pt. was evaluated with intraoperative duplex ultrasound after patch closure (P = 0.19). The mean imaging follow-ups were similar (DL-EJVP: 51, DP: 60 months). There was no difference between the cohorts in the early outcomes, including hemispheric ischemic events. Early death, nerve injury, wound problems, length of stay, and late outcomes, including >50% restenosis, pseudoaneurysm formation, ipsilateral neurologic events, need for reoperation or intervention, and overall survival.

Both DL-EJVP and DP closure of the longitudinal arteriotomy after CEA are durable solutions with similar complication profile. When surgeon's preference, cost reduction or other circumstances would require autologous vein material for CEA closure DL-EJVP can be safely considered.