Expanded polytetrafluoroethylene patch angioplasty in carotid endarterectomy

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Medical Device Technology

Background:

• Carotid artery stenosis poses a significant risk of stroke.
• Surgical intervention, such as carotid endarterectomy, is a common treatment.
• Patch angioplasty is frequently employed to restore arterial lumen after endarterectomy.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of expanded polytetrafluoroethylene (ePTFE) patches in carotid endarterectomy.
• To assess the rates of restenosis, morbidity, and mortality associated with ePTFE patch angioplasty.
• To compare ePTFE patches with autogenous saphenous vein grafts as alternatives.

Main Methods:

• Retrospective review of 924 carotid endarterectomy procedures using ePTFE patches over 17 years.
• Inclusion criteria: stenosis of 80% or greater.
• Follow-up included noninvasive methods, angiography for restenosis confirmation, and life-table analysis.

Main Results:

• Perioperative outcomes: 0.6% mortality, 0.9% nonfatal stroke, 19 hemorrhages, and 2 infections.
• Long-term outcomes: 3.7% recurrent stenosis requiring reoperation, 2 late strokes.
• Life-table analysis showed an 89% probability of remaining free from stenosis at 120 months.

Conclusions:

• ePTFE patches are an excellent alternative to autogenous saphenous vein for carotid endarterectomy.
• Low rates of recurrent stenosis requiring reoperation were observed.
• Acceptable perioperative and postoperative morbidity and mortality support the use of ePTFE patches.