Saphenous vein bypass: an alternative to internal carotid reconstruction

Venous grafting is rarely employed for carotid reconstruction; the aim of this retrospective study was to assess its value as an alternative to endarterectomy.

Between January 1980 and June 1990, we performed 212 carotid artery venous bypasses (CVB) on 208 patients. Twenty-nine patients were asymptomatic, 60 had non-hemispheric symptoms and 119 focal symptoms. The indication for surgery was stenosis in 185 cases, kinking in 18 and aneurysms in nine. The main criteria to use CVB were length of the lesion in 86 cases, extent of atherosclerosis in 75, dysplasia in 12, intraoperative failure of endarterectomy in 21, aneurysms in seven and long-term restenosis or occlusion in 12.

There were 11 deaths, three strokes and nine transient ischaemic attacks. Angiographic control showed one occlusion giving an immediate patency rate of 99.5%. Mean follow-up was 104.3 +/- 46.1 months with 15 patients lost to follow-up. Eighty patients died; life expectancy was 52.4 +/- 7.5 at 10 years. Including occlusions and restenosis as failures, the secondary patency rate was 96.4 +/- 3.7 at 10 years. The annual stroke rate was 1.3% and the neurologic event-free-population 87 +/- 2.4% at 10 years.

CVB is a valuable alternative to endarterectomy for reconstruction of the carotid artery. The indications are extensive atherosclerosis involving the common carotid artery, intraoperative anatomic failure of endarterectomy, and long-term restenosis.