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. 1987 Nov;206(5):628–635. doi: 10.1097/00000658-198711000-00013

A prospective study of vein patch angioplasty during carotid endarterectomy. Three-year results for 801 patients and 917 operations.

N R Hertzer 1, E G Beven 1, P J O'Hara 1, L P Krajewski 1
PMCID: PMC1493295  PMID: 3675024

Abstract

From 1983 through 1985, 801 consecutive patients (mean age: 66 years) underwent 917 primary carotid endarterectomies at the Cleveland Clinic. Conventional arteriotomy closure was performed during 483 operations, while patch angioplasty using a distal segment of saphenous vein was employed in 434. Preoperative risk factors, surgical management, and antiplatelet therapy were equivalent in the vein patch (VP) and nonpatch (NP) groups. Early results were evaluated by intravenous angiography (DSA) in 715 patients (89%), and 332 reconstructions (36%) have been reassessed by objective imaging during a mean follow-up interval of 21 months. Ischemic strokes occurred after 18 (1.9%) of the 917 procedures (0.7% VP, 3.1% NP; p = 0.0084), and symptomatic (N = 9) or unsuspected (N = 8) thrombosis of the internal carotid artery was confirmed by neck exploration or routine DSA after 1.9% of all operations (0.5% VP, 3.1% NP; p = 0.0027). Only ten patients (1.2%) have required reoperations for severe recurrent lesions, but the cumulative 3-year incidence of new defects (greater than or equal to 30% stenosis) documented by objective studies in the VP and NP groups was 9% and 31%, respectively (p = 0.0066). These results strongly suggest that VP angioplasty enhances the safety and durability of carotid endarterectomy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ackroyd N., Lane R., Appleberg M. Carotid endarterectomy. Long term follow-up with specific reference to recurrent stenosis, contralateral progression, mortality and recurrent neurological episodes. J Cardiovasc Surg (Torino) 1986 Jul-Aug;27(4):418–425. [PubMed] [Google Scholar]
  2. Archie J. P., Jr Prevention of early restenosis and thrombosis-occlusion after carotid endarterectomy by saphenous vein patch angioplasty. Stroke. 1986 Sep-Oct;17(5):901–905. doi: 10.1161/01.str.17.5.901. [DOI] [PubMed] [Google Scholar]
  3. Baker W. H., Littooy F. N., Hayes A. C., Dorner D. B., Stubbs D. Carotid endarterectomy without a shunt: the control series. J Vasc Surg. 1984 Jan;1(1):50–56. [PubMed] [Google Scholar]
  4. Barnes R. W., Nix M. L., Wingo J. P., Nichols B. T. Recurrent versus residual carotid stenosis. Incidence detected by Doppler ultrasound. Ann Surg. 1986 Jun;203(6):652–660. doi: 10.1097/00000658-198606000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Barnett H. J., Plum F., Walton J. N. Carotid endarterectomy--an expression of concern. Stroke. 1984 Nov-Dec;15(6):941–943. doi: 10.1161/01.str.15.6.941. [DOI] [PubMed] [Google Scholar]
  6. Brott T. G., Labutta R. J., Kempczinski R. F. Changing patterns in the practice of carotid endarterectomy in a large metropolitan area. JAMA. 1986 May 16;255(19):2609–2612. [PubMed] [Google Scholar]
  7. Brott T., Thalinger K. The practice of carotid endarterectomy in a large metropolitan area. Stroke. 1984 Nov-Dec;15(6):950–955. doi: 10.1161/01.str.15.6.950. [DOI] [PubMed] [Google Scholar]
  8. CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
  9. Cantelmo N. L., Cutler B. S., Wheeler H. B., Herrmann J. B., Cardullo P. A. Noninvasive detection of carotid stenosis following endarterectomy. Arch Surg. 1981 Aug;116(8):1005–1008. doi: 10.1001/archsurg.1981.01380200019003. [DOI] [PubMed] [Google Scholar]
  10. Chambers B. R., Norris J. W. Outcome in patients with asymptomatic neck bruits. N Engl J Med. 1986 Oct 2;315(14):860–865. doi: 10.1056/NEJM198610023151404. [DOI] [PubMed] [Google Scholar]
  11. Chambers B. R., Norris J. W. The case against surgery for asymptomatic carotid stenosis. Stroke. 1984 Nov-Dec;15(6):964–967. doi: 10.1161/01.str.15.6.964. [DOI] [PubMed] [Google Scholar]
  12. Clagett G. P., Rich N. M., McDonald P. T., Salander J. M., Youkey J. R., Olson D. W., Hutton J. E., Jr Etiologic factors for recurrent carotid artery stenosis. Surgery. 1983 Feb;93(2):313–318. [PubMed] [Google Scholar]
  13. Colgan M. P., Kingston V., Shanik G. Stenosis following carotid endarterectomy. Its implication in management of asymptomatic carotid stenosis. Arch Surg. 1984 Sep;119(9):1033–1035. doi: 10.1001/archsurg.1984.01390210037009. [DOI] [PubMed] [Google Scholar]
  14. Cossman D., Callow A. D., Stein A., Matsumoto G. Early restenosis after carotid endarterectomy. Arch Surg. 1978 Mar;113(3):275–278. doi: 10.1001/archsurg.1978.01370150047008. [DOI] [PubMed] [Google Scholar]
  15. Das M. B., Hertzer N. R., Ratliff N. B., O'Hara P. J., Beven E. G. Recurrent carotid stenosis. A five-year series of 65 reoperations. Ann Surg. 1985 Jul;202(1):28–35. doi: 10.1097/00000658-198507000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Deriu G. P., Ballotta E., Bonavina L., Grego F., Alvino S., Franceschi L., Meneghetti G., Saia A. The rationale for patch-graft angioplasty after carotid endarterectomy: early and long-term follow-up. Stroke. 1984 Nov-Dec;15(6):972–979. doi: 10.1161/01.str.15.6.972. [DOI] [PubMed] [Google Scholar]
  17. Dilley R. B., Bernstein E. F. A comparison of B-mode real-time imaging and arteriography in the intraoperative assessment of carotid endarterectomy. J Vasc Surg. 1986 Nov;4(5):457–463. [PubMed] [Google Scholar]
  18. Easton J. D., Sherman D. G. Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke. 1977 Sep-Oct;8(5):565–568. doi: 10.1161/01.str.8.5.565. [DOI] [PubMed] [Google Scholar]
  19. Flanigan D. P., Douglas D. J., Machi J., Siegel B., Schuler J. J., Buchbinder D. Intraoperative ultrasonic imaging of the carotid artery during carotid endarterectomy. Surgery. 1986 Nov;100(5):893–899. [PubMed] [Google Scholar]
  20. Hertzer N. R., Arison R. Cumulative stroke and survival ten years after carotid endarterectomy. J Vasc Surg. 1985 Sep;2(5):661–668. [PubMed] [Google Scholar]
  21. Hertzer N. R., Beven E. G., Greenstreet R. L., Humphries A. W. Internal carotid back pressure, intraoperative shunting, ulcerated atheromata, and the incidence of stroke during carotid endarterectomy. Surgery. 1978 Mar;83(3):306–312. [PubMed] [Google Scholar]
  22. Hertzer N. R., Beven E. G., Modic M. T., O'Hara P. J., Vogt D. P., Weinstein M. A. Early patency of the carotid artery after endarterectomy: digital subtraction angiography after two hundred sixty-two operations. Surgery. 1982 Dec;92(6):1049–1057. [PubMed] [Google Scholar]
  23. Hertzer N. R., Flanagan R. A., Jr, Beven E. G., O'Hara P. J. Surgical versus nonoperative treatment of asymptomatic carotid stenosis. 290 patients documented by intravenous angiography. Ann Surg. 1986 Aug;204(2):163–171. doi: 10.1097/00000658-198608000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Hertzer N. R., Flanagan R. A., Jr, Beven E. G., O'Hara P. J. Surgical versus nonoperative treatment of symptomatic carotid stenosis. 211 patients documented by intravenous angiography. Ann Surg. 1986 Aug;204(2):154–162. doi: 10.1097/00000658-198608000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hertzer N. R., Martinez B. D., Benjamin S. P., Beven E. G. Recurrent stenosis after carotid endarterectomy. Surg Gynecol Obstet. 1979 Sep;149(3):360–364. [PubMed] [Google Scholar]
  26. Imparato A. M., Weinstein G. S. Clinicopathologic correlation in postendarterectomy recurrent stenosis. A case report and bibliographic review. J Vasc Surg. 1986 Apr;3(4):657–662. [PubMed] [Google Scholar]
  27. Kremen J. E., Gee W., Kaupp H. A., McDonald K. M. Restenosis or occlusion after carotid endarterectomy: a survey with ocular pneumoplethysmography. Arch Surg. 1979 May;114(5):608–610. doi: 10.1001/archsurg.1979.01370290058011. [DOI] [PubMed] [Google Scholar]
  28. Lee E. T., Desu M. M. A computer program for comparing K samples with right-censored data. Comput Programs Biomed. 1972 Nov;2(4):315–321. doi: 10.1016/0010-468x(72)90019-0. [DOI] [PubMed] [Google Scholar]
  29. Moore D. J., Miles R. D., Gooley N. A., Sumner D. S. Noninvasive assessment of stroke risk in asymptomatic and nonhemispheric patients with suspected carotid disease. Five-year follow-up of 294 unoperated and 81 operated patients. Ann Surg. 1985 Oct;202(4):491–504. doi: 10.1097/00000658-198510000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Moore D. J., Sheehan M. P., Kolm P., Russell J. B., Sumner D. S. Are strokes predictable with noninvasive methods: a five-year follow-up of 303 unoperated patients. J Vasc Surg. 1985 Sep;2(5):654–660. [PubMed] [Google Scholar]
  31. Ortega G., Gee W., Kaupp H. A., McDonald K. M. Postendarterectomy carotid occlusion. Surgery. 1981 Dec;90(6):1093–1098. [PubMed] [Google Scholar]
  32. Painter T. A., Hertzer N. R., O'Hara P. J., Krajewski L. P., Beven E. G. Symptomatic internal carotid thrombosis after carotid endarterectomy. J Vasc Surg. 1987 Mar;5(3):445–451. doi: 10.1067/mva.1987.avs0050445. [DOI] [PubMed] [Google Scholar]
  33. Piepgras D. G., Sundt T. M., Jr, Marsh W. R., Mussman L. A., Fode N. C. Recurrent carotid stenosis. Results and complications of 57 operations. Ann Surg. 1986 Feb;203(2):205–213. doi: 10.1097/00000658-198602000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Stoney R. J., String S. T. Recurrent carotid stenosis. Surgery. 1976 Dec;80(6):705–710. [PubMed] [Google Scholar]
  35. Sundt T. M., Jr, Houser O. W., Fode N. C., Whisnant J. P. Correlation of postoperative and two-year follow-up angiography with neurological function in 99 carotid endarterectomies in 86 consecutive patients. Ann Surg. 1986 Jan;203(1):90–100. doi: 10.1097/00000658-198601000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Thomas M., Otis S. M., Rush M., Zyroff J., Dilley R. B., Bernstein E. F. Recurrent carotid artery stenosis following endarterectomy. Ann Surg. 1984 Jul;200(1):74–79. doi: 10.1097/00000658-198407000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Turnipseed W. D., Berkoff H. A., Crummy A. Postoperative occlusion after carotid endarterectomy. Arch Surg. 1980 May;115(5):573–574. doi: 10.1001/archsurg.1980.01380050005002. [DOI] [PubMed] [Google Scholar]
  38. Warlow C. Carotid endarterectomy: does it work? Stroke. 1984 Nov-Dec;15(6):1068–1076. doi: 10.1161/01.str.15.6.1068. [DOI] [PubMed] [Google Scholar]
  39. Zierler R. E., Bandyk D. F., Thiele B. L., Strandness D. E., Jr Carotid artery stenosis following endarterectomy. Arch Surg. 1982 Nov;117(11):1408–1415. doi: 10.1001/archsurg.1982.01380350016003. [DOI] [PubMed] [Google Scholar]

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