Carotid bypass with polytetrafluoroethylene grafts: a study of 110 consecutive patients.
BACKGROUND
Carotid endarterectomy (CEA) is the standard treatment for atherosclerotic lesions involving the carotid bifurcation. However, CEA can be challenging under some conditions. We describe the technique and outcome of prosthetic carotid bypass grafting (PCB) with polytetrafluoroethylene (PTFE) grafts as an elective alternative to CEA.


METHODS
This retrospective analysis of prospectively collected data came from a series of 110 consecutive PCBs, that is, 9.6% of 1140 carotid revascularization procedures performed in our department between September 1986 and July 2002. Primary indications for PCB were extensive atherosclerotic lesions (n = 45, 40.9%), carotid stenosis associated with kinking (n = 29, 26.4%), recurrent stenosis (n = 18, 16.4%), and stenosis after radiation therapy (n = 7, 6.4%).


RESULTS
The combined stroke and death rate at 30 days was 0.9%. Mean duration of follow-up was 647 +/- 71 days. Four carotid bypass grafts (3.6%) became occluded, and stenosis recurred in 1 (0.9%). At 3 years, overall actuarial survival was 81.4 +/- 11.5 and actuarial stroke-free rate was 97.7 +/- 2.3. There were no fatal strokes.


CONCLUSIONS
PCB is a viable technique for treatment of extensive atherosclerotic carotid lesions, recurrent carotid stenosis, and carotid stenosis after radiation therapy. Postoperative stroke, occlusion, and recurrent stenosis rates are comparable to those associated with CEA performed under optimal conditions.
Camiade
Christophe
C
Vascular Surgery Department, Jean Bernard University Hospital, Poitiers, France.
Maher
Amer
A
Ricco
Jean-Baptiste
JB
Roumy
Jérôme
J
Febrer
Guillaume
G
Marchand
Christophe
C
Neau
Jean-Philippe
JP
D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016893:Carotid Stenosis / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene