title: Retrospective analysis of bovine pericardium (Vascu-Guard) for patch closure in carotid endarterectomies.
abstract: BACKGROUND
  It has been shown that patch closure after carotid endarterectomy (CEA) decreases the rate of recurrent stenosis. This study was designed to evaluate the utility of bovine pericardium patch as an option for patch closure after CEA.
  
  
  METHODS
  This retrospective study examined 845 CEAs with bovine patch closure that were performed by the surgeons of Indiana-Ohio Heart, Fort Wayne, IN, between May 2003 and March 2009. The average age of the patients was 72.7 ± 10.6 years and postoperative follow-up was performed using duplex ultrasound at (ideally) 1 month, 6 months, 12 months, and annually thereafter. The average duration of follow-up for this study was 19.2 ± 16.8 months (ranging from 1 day to 72 months). All patients were evaluated for demographics and postoperative medications. Restenosis was categorized in three ways: nonsignificant (0-59% narrowing of the artery), significant (60-79%), or critical (80-99%). A total of 796 arteries were studied at least once during the postoperative period.
  
  
  RESULTS
  None of the postoperative duplex studies revealed occlusion of the endarterectomized artery. At the mean follow-up duration, 323 endarterectomized arteries were studied. In all, 24 arteries (7.43%) had significant stenosis and only two (0.62%) had critical stenosis. These numbers compare favorably with the recurrent restenosis rates of other materials. Additionally, the effect of statins on restenosis rates was studied. We were unable to demonstrate a beneficial effect of postoperative statin therapy on restenosis rates.
  
  
  CONCLUSIONS
  The use of bovine pericardium for patch closure in CEA yields excellent freedom from residual or recurrent postoperative stenosis and the use of statins postoperatively failed to reduce the likelihood of residual or recurrent stenosis.
authors.affiliation: Indiana/Ohio Heart Cardiothoracic and Vascular Surgeons, Ft. Wayne, Indiana, USA. jsl@ioheart.com
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Ladowski
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ladowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002417:Cattle; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007196:Indiana; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010496:Pericardium / Q000637:transplantation*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors