title: Patch variability following carotid endarterectomy: a survey of Great Britain and Ireland.
abstract: BACKGROUND
  Evidence suggests a clinical benefit with patch angioplasty after carotid endarterectomy (CEA). The UK National Vascular Database has demonstrated variation in practice but does not record technical details. This study was intended to define indications and technique of patching after CEA.
  
  
  METHODS
  An electronic questionnaire was emailed to all 402 members of the Vascular Society of Great Britain and Ireland. The email could not be received by 23 and 14 did not perform CEA. Some questions allowed multiple answers. Fisher's exact test was used for statistical analysis.
  
  
  RESULTS
  There were 187 responses (51%). Fifteen members (8%) performed eversion CEA, which obviates patching. Of all the respondents, 121 surgeons (65%) always use a patch. Seventy of these (58%) use the full patch width (median: 8 mm, range: 4-10 mm). Fourteen (12%) variably trimmed the patch (median: 7.5 mm, range: 5-10 mm) and 34 (28%) routinely trimmed (median: 6 mm, range: 3-20 mm). Selective patching, dependent on internal carotid artery diameter, was performed by 48 respondents (26%), 23 of whom specified a median artery threshold diameter of 5 mm (range: 3-8 mm). General anaesthesia was always or usually used by 83 surgeons (45%), local anaesthesia by 77 (41%) and the remainder followed patient choice. Obligatory patching is performed by 68 of the 83 respondents (82%) who prefer general anaesthesia whereas only 40 of the 77 surgeons (52%) who use local anaesthesia always patch (p<0.0001).
  
  
  CONCLUSIONS
  There is a variable rate of patching after CEA in the UK, which appears dependent on the vessel size and mode of anaesthesia. There are also differences in the patch width adopted.
authors.affiliation: Royal Liverpool University Hospital NHS Trust, Liverpool, UK. garethjamesharrison@yahoo.co.uk
authors.forename: G J
authors.initials: GJ
authors.lastname: Harrison
authors.forename: J A
authors.initials: JA
authors.lastname: Brennan
authors.forename: J B
authors.initials: JB
authors.lastname: Naik
authors.forename: S R
authors.initials: SR
authors.lastname: Vallabhaneni
authors.forename: R K
authors.initials: RK
authors.lastname: Fisher
mesh_terms: D000768:Anesthesia, General / Q000706:statistics & numerical data; D000772:Anesthesia, Local / Q000706:statistics & numerical data; D017130:Angioplasty / Q000379:methods*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013526:Surgical Mesh / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000706:statistics & numerical data; D006113:United Kingdom