Should proximal saphenous vein be used for carotid patch angioplasty: a clinical study of the need for vein in subsequent operations.
Reluctance to use saphenous vein (SV) for patch closure of the carotid arteriotomy is due in part to the concern of vascular surgeons that the SV should be preserved for possible future coronary or lower extremity reconstruction. Even among those who favour vein patch closure of the arteriotomy for improved immediate and late results, an effort has been made to use the ankle portion of the SV, preserving the upper, larger segment for later surgery. Recent reports of rupture of the patches formed from ankle SV and a study showing a decrease in strength of the ankle segment of vein, raised the question of the importance of trying to preserve the proximal SV and the impact of use of this segment in those patients requiring secondary vascular procedures. We reviewed 134 consecutive carotid patients from 1981 who had proximal SV harvested for patch angioplasty. Of those 122 were available (mean 44.9 months). Thirteen had secondary vascular procedures. Adequate saphenous vein was available in twelve. We conclude from this study that (1) less than 15% of patients undergoing carotid surgery will require a secondary vascular surgery within 5 years and (2) harvesting SV from the thigh rarely compromises future revascularisation.
de Vries
A C
AC
Department of Surgery, New York University Medical Centre, N.Y. 10016.
Riles
T S
TS
Lamparello
P J
PJ
Giangola
G
G
Landis
R
R
D000368:Aged; D002339:Carotid Arteries / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*