Patching with carotid endarterectomy: when to do it and what to use.
This is an analysis of published data on the outcomes of carotid endarterectomy patch reconstruction with the commonly used materials--autologous greater saphenous vein, Dacron, and polytetrafluoroethylene. Taken individually, these prospective randomized, prospective nonrandomized, and retrospective studies have mixed findings with respect to both the advantage of patching over primary closure and the superiority, if any, of one patch material. A major problem with these reports is small sample size and the associated low statistical power of tests on outcomes. Comparative outcomes are often marginally statistically significant or not significant at the .05 level. However, when the data from similarly designed studies are pooled, as with a meta-analysis, the sample sizes are large enough to allow definitive statistical evaluation. This analysis indicates that obligatory patching or selectively patching more than 90% of carotid endarterectomies gives clearly superior outcomes (in terms of early postoperative thrombosis, perioperative stroke, and 50% or more residual or restenosis in the first year) when compared with primary closure. There is softer, but clearly important, evidence that carotid endarterectomy patch reconstruction with greater saphenous vein has better perioperative stroke and restenosis outcomes than that obtained with Dacron and polytetrafluoroethylene.
Archie
J P
JP
University of North Carolina, Chapel Hill, USA.
D001807:Blood Vessel Prosthesis; D016893:Carotid Stenosis / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D019651:Plastic Surgery Procedures; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors
D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene