Outcome of selective patching following carotid endarterectomy.
OBJECTIVE
Routine patch angioplasty has been advocated following carotid endarterectomy but patching can be associated with complications. This study assesses the effect of a selective patching policy based on distal internal carotid diameter on the rate of restenosis and outcome following carotid endarterectomy.


METHODS
A consecutive series of 213 patients underwent carotid endarterectomy performed by one surgeon. Preoperative carotid dimensions were measured intraoperatively using calipers. Following endarterectomy a 5mm Dacron patch was selectively employed if the distal internal carotid was 5mm or less (group 1, 95 patients) or 6mm or less (group 2, 118 patients). Patients underwent colour-coded Duplex scanning at 24 h, 1 week, 3, 6, 9, and 12 months, and yearly following this.


RESULTS
Overall 27 restenoses (5 residual) of 50% or greater and two occlusions developed. Patching was performed in 47% of group 1 and 61% of group 2 arteries. In group 1 14% of patched compared with 24% of non-patched arteries developed restenosis at 24 months (p=0.4). In group 2 13% of patched compared to 11% of non-patched arteries developed restenosis at 12 months (p>0.5). Stroke rate at 24 months were similar for patched and non-patched patients in groups 1 (p>0.5) and 2 (p=0.4).


CONCLUSIONS
This study suggests that patch angioplasty of larger carotid arteries may be unnecessary. Randomisation of larger arteries between patch and primary closure would be required to confirm this.
Golledge
J
J
Department of Surgery, Charing Cross and Westminster Medical School, London, U.K.
Cuming
R
R
Davies
A H
AH
Greenhalgh
R M
RM
D000368:Aged; D017130:Angioplasty / Q000379:methods*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D016022:Case-Control Studies; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D011093:Polyethylene Terephthalates