title: Systematic review of randomized controlled trials of different types of patch materials during carotid endarterectomy.
abstract: OBJECTIVE
  Carotid endarterectomy (CEA) with patch angioplasty produces greater results than with primary closure; however, there remains uncertainty on the optimal patch material in CEA. A systematic review of randomized controlled trials (RCTs) was performed to evaluate the effect of angioplasty using venous patch versus synthetic patch material, and Dacron patch versus polytetrafluoroethelene (PTFE) patch material during CEA.
  
  
  METHODS
  A multiple electronic health database screening was performed including the Cochrane library, Pubmed, Ovid, EMBASE and Google Scholar on all randomized controlled trials (RCTs) published before November 2012 that compared the outcomes of patients undergoing CEA with venous patch versus synthetic patch. RCTs were included if they compared carotid patch angioplasty with autologus venous patch versus synthetic patch material, or compared one type of synthetic patch with another.
  
  
  RESULTS
  Thirteen RCTs were identified. Ten trials, involving 1946 CEAs, compared venous patch with synthetic patch materials. Two trials, involving 400 CEAs in 380 patients, compared Dacron patch with PTFE patch. The hemostasis time in CEA with PTFE patch was significantly longer than with venous patch (P<0.0001), and longer than with Dacron patch (P<0.0001). There was no significant difference of mortality rate, stroke rate, restenosis, and operative time in CEA with venous patch versus synthetic patch material, or in CEA with Dacron patch versus PTFE patch (all P>0.05). One RCT of 95 CEAs in 92 patients compared bovine pericardium with Dacron patch, and demonstrated a statistically significant decrease in intraoperative suture line bleeding with bovine pericardium compared with Dacron patch (P<0.001).
  
  
  CONCLUSIONS
  The hemostasis time in CEA with PTFE patch was longer than with venous patch or Dacron patch. The overall perioperative and long-term mortality rate, stroke rate, restenosis, and operative time were similar when using venous patch versus synthetic patch material or Dacron patch versus PTFE patch material during CEA. More data are required to clarify differences between different patch materials.
authors: Cardiovascular Center, China-Japan Friendship Hospital, Beijing, People's Republic of China. shiyanr@yahoo.com
authors: Shiyan
authors: S
authors: Ren
authors: Xianlun
authors: X
authors: Li
authors: Jianyan
authors: J
authors: Wen
authors: Wenjian
authors: W
authors: Zhang
authors: Peng
authors: P
authors: Liu
mesh_terms: D017130:Angioplasty / Q000379:methods*; D000818:Animals; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D010496:Pericardium / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
references: J Vasc Surg. 1996 Dec;24(6):998-1006; discussion 1006-7
references: 8976353
references: J Vasc Surg. 1989 Apr;9(4):521-9
references: 2709521
references: Arch Surg. 2002 Jul;137(7):785-8
references: 12093332
references: Cochrane Database Syst Rev. 2000;(2):CD000160
references: 10796309
references: J Vasc Surg. 2004 May;39(5):985-93; discussion 993
references: 15111849
references: Cochrane Database Syst Rev. 2010 Mar 17;(3):CD000071
references: 20238308
references: Arch Surg. 1987 Mar;122(3):364-71
references: 3827579
references: Eur J Vasc Endovasc Surg. 2008 Jul;36(1):45-52
references: 18396071
references: Ann Vasc Surg. 1990 May;4(3):209-12
references: 2140271
references: Ann Vasc Surg. 1987 Dec;1(5):583-6
references: 2974302
references: J Cardiovasc Surg (Torino). 1994 Dec;35(6):523-8
references: 7698967
references: Eur J Vasc Endovasc Surg. 2011 Sep;42 Suppl 1:S39-40
references: 21855018
references: J Vasc Surg. 1998 Feb;27(2):222-32; discussion 233-4
references: 9510277
references: J Vasc Surg. 1989 Feb;9(2):213-23
references: 2645441
references: Ann Surg. 2003 Jun;237(6):885-92; discussion 892-3
references: 12796586
references: J Vasc Surg. 2001 May;33(5):994-1000
references: 11331840
references: J Vasc Surg. 2005 Mar;41(3):403-7; discussion 407-8
references: 15838471
references: Control Clin Trials. 1996 Feb;17(1):1-12
references: 8721797
references: J Mal Vasc. 1994;19 Suppl A:10-7
references: 8158065
references: Cochrane Database Syst Rev. 2011 Apr 13;(4):CD001081
references: 21491381
references: J Cardiovasc Surg (Torino). 1990 Jan-Feb;31(1):58-65
references: 2182643
references: J Vasc Surg. 2002 Jan;35(1):125-30
references: 11802143
references: Ann Thorac Cardiovasc Surg. 2012;18(3):228-35
references: 22790995
references: Cochrane Database Syst Rev. 2004;(2):CD000071
references: 15106141
references: Eur J Vasc Endovasc Surg. 2011 Dec;42(6):766-74
references: 21945512
references: Surgery. 1996 Mar;119(3):297-301
references: 8619185
references: Asian J Surg. 2011 Jan;34(1):32-40
references: 21515211
references: J Vasc Surg. 2003 Dec;38(6):1232-40
references: 14681620
references: J Vasc Surg. 2007 May;45(5):881-4
references: 17466785
references: Am J Surg. 1991 Jul;162(1):50-4
references: 2063970
references: J Vasc Surg. 2002 Feb;35(2):324-32
references: 11854731
references: J Vasc Surg. 2004 Dec;40(6):1126-35
references: 15622366