title: Carotid replacement with Dacron graft in 292 patients.
abstract: BACKGROUND
  In case of highly atherosclerotic carotid process, carotid graft replacement might be a potential solution for successful procedure. Many studies evaluated the results of vein and polytetrafluorethilen (PTFE) graft usage at the carotid bifurcation, while the experience on the Dacron graft due to extensive atherosclerotic process is missing. The aim of our study was to evaluate 30-day and long-term results of the Dacron graft on carotid artery used in patients with extensive atherosclerotic disease.
  
  
  METHODS
  This retrospective study analysed early and long-term neurological outcome as well as Dacron graft patency in patients operated with carotid reconstruction. Early results were confirmed by follow-up clinical examination, whereas late results were assessed by follow-up clinical examination as well as duplex sonographic examination at least 1 year after the surgery. As for statistical methods we used descriptive analysis tests, Chi-square test, and logistic regression.
  
  
  RESULTS
  Carotid graft replacement was performed in 292 patients, before endarterectomy in 155 (53.09%), or after already attempted unsuccessful eversion endarterectomy in 137 (46.91%). Nineteen (6.5%) patients had a stroke due to ipsilateral and contralateral ischaemia or haemorrhagic in 17 (5.8%), 1 (0.3%) and 1 (0.3%) patients, respectively. Significantly higher rate of strokes occurred when the graft reconstruction was used after the failure of endarterectomy (8.5% vs. 3.5%, p = 0.029). Stroke and death rate was 7.19%. Factors that increased risk of early stroke were the length of plaque in the internal carotid artery measured intraoperatively (p = 0.025) and the surgical tactic to perform graft reconstruction after attempted extensive endarterectomy (p = 0.029).
  
  
  CONCLUSIONS
  Low number of patients with carotid stenosis has extensive atherosclerotic process longer than 4 cm that might jeopardise eversion endarterectomy. Carotid graft replacement with Dacron graft provide early results that are comparable with other conduits; however, in such patients reconstruction should be selected individually based on surgical experience and anatomical distribution of stenotic disease. Due to high risk of stroke, only symptomatic patients with such extensive atherosclerotic disease should be operated.
authors.affiliation: Faculty of Medical, University of Belgrade, Serbia dr.koncar@gmail.com.|Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Igor
authors.initials: I
authors.lastname: Koncar
authors.affiliation: Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Jelena Z
authors.initials: JZ
authors.lastname: Ribac
authors.affiliation: Faculty of Medical, University of Belgrade, Serbia.|Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Nikola S
authors.initials: NS
authors.lastname: Ilic
authors.affiliation: Faculty of Medical, University of Belgrade, Serbia.|Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Marko
authors.initials: M
authors.lastname: Dragas
authors.affiliation: Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Perica
authors.initials: P
authors.lastname: Mutavdzic
authors.affiliation: Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Ivan Z
authors.initials: IZ
authors.lastname: Tomic
authors.affiliation: Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Ristanovic
authors.affiliation: Faculty of Medical, University of Belgrade, Serbia.|Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Dusan
authors.initials: D
authors.lastname: Kostic
authors.affiliation: Faculty of Medical, University of Belgrade, Serbia.|Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Lazar
authors.initials: L
authors.lastname: Davidovic
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D058226:Plaque, Atherosclerotic; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
chemical_list: D011093:Polyethylene Terephthalates
keywords: Carotid stenosis; complications; graft replacement