Is the use of ankle saphenous vein for carotid artery patch closure justified?

Saphenous vein patch angioplasty has been introduced to prevent early and late restenosis after carotid artery endarterectomy. We describe a case of vein patch rupture on the first postoperative day, resulting in death of a hypertensive female patient. Although the incidence of this complication is low (0.5 to 1%), the morbidity and mortality rate is dramatically high when it occurs. In similar cases published, saphenous vein harvested from the ankle is involved almost exclusively, suggesting that small-diameter veins have a higher risk of rupture when used as a carotid patch. Old age, female gender, diabetes and arterial hypertension seem to be further factors negatively influencing the physical properties of the vein. Therefore, if a venous patch is needed in selected patients most probably in female patients with small internal carotid arteries, it seems appropriate to use the proximal part of the saphenous vein from the groin or the thigh.