title: Carotid-carotid crossover bypass: is it a durable procedure?
abstract: OBJECTIVE
  Reconstruction of a diseased common carotid artery may necessitate direct repair via aortic artery-based revascularization. However, carotid-carotid artery crossover grafting is an alternative extra-anatomic option that obviates the need for median sternotomy. We analyzed our results with carotid-carotid artery crossover bypass surgery.
  
  
  METHODS
  Data were analyzed for all patients undergoing carotid-carotid crossover bypass surgery from 1995 to 2000. Data on patient demographics, indications for surgery, perioperative morbidity and mortality, and graft patency were retrieved from a vascular surgery data base and hospital records. Stroke-free survival and graft patency were determined with life table methods.
  
  
  RESULTS
  Over 5 years, 24 carotid-carotid artery crossover bypass procedures were performed to treat both symptomatic (n = 19, 79%) and asymptomatic (n = 5, 17%) disease. Nine procedures (38%) were performed in men, 3 (13%) in patients with diabetes, 12 (50%) in active smokers, and 2 in patients with a history of Takayasu arteritis. Patient mean age was 63 years (range, 38-79 years). Twenty-three patients (96%) received polytetrafluoroethylene conduit grafts, and the remaining patients received vein grafts. Ten (42%) patients underwent concomitant endarterectomy. There were no perioperative deaths. One patient (4%) had asymptomatic early occlusion, one had transient neurologic deficit (4%), one (4%) required additional surgery because of bleeding, and one (4%) had a perioperative cerebrovascular accident (stroke). Three (17%) asymptomatic late occlusions were identified at 11, 57, and 64 months, respectively. Mean follow-up was 30 months (range, 1-70 months). Primary patency was 88%, and secondary patency was 92% at 3 years. Stroke-free survival was 94% at 4 years.
  
  
  CONCLUSIONS
  Carotid-carotid artery crossover bypass surgery is a safe and durable procedure. Its use precludes the need for median sternotomy and provides acceptable stroke-free survival.
authors.affiliation: Institute for Vascular Health and Disease, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Ozsvath
authors.forename: Sean P
authors.initials: SP
authors.lastname: Roddy
authors.forename: R Clement
authors.initials: RC
authors.lastname: Darling
authors.forename: John
authors.initials: J
authors.lastname: Byrne
authors.forename: Paul B
authors.initials: PB
authors.lastname: Kreienberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Choi
authors.forename: Philip S K
authors.initials: PS
authors.lastname: Paty
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Chang
authors.forename: Manish
authors.initials: M
authors.lastname: Mehta
authors.forename: Dhiraj M
authors.initials: DM
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000601:surgery; D017536:Carotid Artery, Common; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D012189:Retrospective Studies; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation
chemical_list: D011138:Polytetrafluoroethylene