Choice of material for internal carotid artery bypass grafting: vein or prosthetic? Analysis of 44 procedures.
OBJECTIVE
Although infrequent, reconstruction of the internal carotid artery due to recurrent or extensive disease, tumor, or difficulty in completing the endarterectomy, may be necessary. Few studies evaluate the type of material used as conduit in regard to outcome. In this report we detail our results using both prosthetic and vein bypass of the internal carotid artery for atherosclerotic bifurcation stenosis.


METHODS
All patients undergoing carotid artery reconstruction over the last 10 years were retrieved from our vascular registry. Those patients requiring bypass of the internal carotid artery were included. Demographics, indication, complications, and long term follow-up were reviewed. Chi square and log rank analysis was used to compare bypass with PTFE to those with vein as conduit.


RESULTS
Over the last 10 years, 44 reconstructions of the internal carotid artery were performed in 41 patients. Twenty-two procedures used prosthetic and 22 used vein. Asymptomatic carotid artery occlusive disease was identified in 14 of the 22 procedures with PTFE, and in 10 of 22 patients with vein. There was no operative mortality in the prosthetic group, and one patient died of a stroke (4.5%) in the vein graft group. There were no strokes or occlusions in the PTFE group. Two permanent neurologic deficits (9%) and one occlusion occurred in the vein bypass group. In follow-up, there have been no late occlusions in the PTFE group, and three in the vein group.


CONCLUSIONS
While endarterectomy is the procedure of choice in carotid bifurcation stenosis, internal carotid artery bypass can be performed with reasonable outcomes whenever necessary. Prosthetic reconstruction of the internal carotid artery had acceptable results that was comparable to vein graft reconstruction.
Roddy
Sean P
SP
Vascular Institute (MC-157), Albany Medical College, 47 New Scotland Avenue, NY Albany 12208, USA.
Darling
R Clement
RC
Ozsvath
Kathleen J
KJ
Mehta
Manish
M
Chang
Benjamin B
BB
Paty
Philip S K
PS
Kreienberg
Paul B
PB
Shah
Dhiraj M
DM
D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D012501:Saphenous Vein / Q000637:transplantation; D020521:Stroke / Q000517:prevention & control; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency
D011138:Polytetrafluoroethylene