Comparison of saphenous vein patch, polytetrafluoroethylene patch, and direct arteriotomy closure after carotid endarterectomy. Part I. Perioperative results

Abstract

To evaluate the perioperative outcomes and the immediate increases in size after patch closure, 140 carotid endarterectomies were randomized into one of three groups: direct no-patch closure, saphenous vein patch closure, and polytetrafluoroethylene patch closure. Seven patients (4.4%) experienced signs of cerebral ischemia in the immediate postoperative period. In three cases this was transient and reversible. In the other four reexploration was undertaken and carotid thrombosis was corrected by thrombectomy. The condition of one of these patients deteriorated to a permanent stroke, whereas the other patients made a complete recovery. Neurologic complications were more frequent in the no-patch group, but the differences between the groups were not significant. The incidence of perioperative internal carotid stenosis, aneurysmal dilatation, and other morphologic abnormalities was assessed in 131 intravenous digital subtraction angiograms taken before the patient was discharged from the hospital. Eight (17.0%) of the endarterectomies in the no-patch group were narrowed by 30% to 50% diameter stenosis, whereas none of the patched arteries had more than 30% stenosis. In contrast, dilatation of the common or internal carotid artery to more than twice the measured diameter was absent in non-patched arteries but was present in seven (17.0%) saphenous patch closures and four (9.23%) polytetrafluoroethylene patch closures. We conclude that patch closure after carotid endarterectomy is less likely to cause stenosis in the perioperative period. Poly-tetrafluoroethylene patches resist dilatation better than do saphenous vein patches and are less likely to become aneurysmal.

Sugarcane biopolymer patch in femoral vein angioplasty on dogs

“…Miyamotto et al, in 2009, in an experimental study comparing bovine pericardium patch with greater saphenous vein patch, concluded that the bovine pericardium patch had a higher rupture resistance than that observed in the greater saphenous vein group. Lord et al, in 1989, reported that PTFE patches, when used after carotid endarterectomy, resisted dilatation better than saphenous vein patches. In this study, dilatation was observed in 9.23% of the PTFE patches and in 17% of the saphenous vein patches.…”

“…Menon et al, in 1973, in an experimental study performed on dogs, reported only one case of dilation in 30 Dacron patch angioplasties over the abdominal aorta and carotid and femoral arteries. 23,[28][29][30] The time of clinical observation in the experimental studies using patches has been varied. The time course used in this study to evaluate the patches was the same reported by Sarac et al in 2006, when they described the efficacy of bovine peritoneum/fascia patches in femoral artery angioplasty on dogs.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary

“…Hemodynamically significant recurrent stenosis rates of 5% to 7% have been reported in multicenter trials (62,176,276,(282)(283)(284)(285)(286)(287)(288)(289)(290)(291)(292)(293)(294)(295)(296)(297)(298)(299). Data comparing restenosis after CEA and CAS must be interpreted cautiously because of selection bias and stentgenerated artifacts in ultrasound velocity measurements.…”

The role of vein grafts in peripheral vascular disease and carotid artery disease

“…Results from a number of trials are available comparing CEA using vein from different sources or synthetic patch (PTFE or Dacron) [42][43][44][45][46][47]. Even though more than 1200 patients were included in these studies and reviewed in two systematic reviews [41,48], the presented data were still insufficient to firmly recommend one type of patch over the other.…”