Long-term follow-up of patients undergoing reoperation for recurrent carotid artery disease.
OBJECTIVE
We examined the perioperative course and long-term fate of individuals who required reoperation for recurrent carotid artery disease.


METHODS
The records of 2289 patients undergoing 2961 consecutive operations during a 22-year period were reviewed. Forty-two patients (1.8%) who underwent reoperations were studied. Forty-seven redo carotid artery reconstructions were performed on these 42 patients for neurologic symptoms or asymptomatic high-grade stenosis. Long-term follow-up was obtained on 41 of 42 patients (mean 54 months; range 9 to 202 months).


RESULTS
The forty-seven reoperations consisted of endarterectomy with patch angioplasty (n = 36), saphenous vein or polytetrafluoroethylene interposition graft (n = 7), or simply vein or polytetrafluoroethylene patch angioplasty (n = 4). There were no perioperative strokes or deaths. Three patients had perioperative transient ischemic attacks and two had cranial nerve injuries. The incidence of late failure after secondary surgery was 19.5% (8/41 patients). These failures consisted of one stroke, three transient ischemic attacks, and four asymptomatic occlusions. One tertiary carotid artery reconstruction was performed for a restenosis at the site of the secondary reconstruction.


CONCLUSIONS
The factors responsible for the high incidence of late failures after secondary carotid artery reconstruction are unclear. Reoperation for recurrent carotid artery disease appears less durable than primary carotid endarterectomy. Close postoperative surveillance is recommended after carotid artery reoperation.
Gagne
P J
PJ
Department of Surgery, New York University Medical Center, NY 10016.
Riles
T S
TS
Jacobowitz
G R
GR
Lamparello
P J
PJ
Giangola
G
G
Adelman
M A
MA
Imparato
A M
AM
Mintzer
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D001807:Blood Vessel Prosthesis; D002340:Carotid Artery Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors
D011138:Polytetrafluoroethylene