Polyester vs. bovine pericardial patching during carotid endarterectomy: early neurologic events and incidence of restenosis.
OBJECTIVE
The aim of this report was to compare polyester vs. bovine pericardial patching during CEA with regards to the incidence of early neurologic events and recurrent stenosis.


METHODS
One hundred and twenty-five consecutive patients with high grade symptomatic (14%) or asymptomatic (86%) carotid artery stenosis (>70%) who underwent 139 CEAs by a single surgeon between January 1997 and April 2001 were retrospectively reviewed. Patients were assessed postoperatively clinically and with routine follow-up duplex scanning. Recurrent stenosis was defined as a narrowing in the common or internal carotid artery of more than 50% by duplex ultrasound examination.


RESULTS
From January 1997 to May 1999, a polyester patch was routinely used in 81 (58%) patients, while between June 1999 and April 2001, a bovine pericardium patch was exclusively used in 59 (42%) patients. There were no ipsilateral postoperative TIAs or strokes in either group. The combined 30-day mortality rate for both groups was 0.8%. One patient in the polyester patch group died from cardiopulmonary complications 10 days after discharge. The length of follow-up in the bovine pericardial patch group was 3-28 months (mean 12 months), while in the polyester patch group was 1-50 months (mean 24.5 month). One patient developed a carotid pseudoaneurysm of the suture line in the bovine pericardium patch group caused by a local infection after previous neck dissection and radiation. The incidence of recurrent stenosis was two patients (4%) in the bovine pericardium group as opposed to six patients (7.6%) in the polyester patch group.


CONCLUSIONS
Although this is a preliminary report, it is concluded that bovine pericardium provides excellent perioperative results and is at least comparable to polyester patching in terms of safety. Our study with short term follow up suggests that bovine pericardium patching during carotid endarterectomy may have a lower restenosis rate compared to knitted polyester patching. Clear superiority of bovine pericardium as a patch material awaits a prospective randomised study with long-term follow-up.
Neuhauser
Beate
B
Mayo Clinic Jacksonville, Department of Vascular Surgery, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
Oldenburg
W Andrew
WA
D000368:Aged; D001705:Bioprosthesis; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011091:Polyesters; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency
D011091:Polyesters