Hemodynamic Effects of Primary Closure Versus Patch Angioplasty of the Carotid Artery

Fietsam, Robert; Ranval, Timothy J.; Cohn, Steven; Brown, O. William; Bendick, Phillip J.; Glover, John L.

doi:10.1007/bf02007000

Cited by 27 publications

(12 citation statements)

References 20 publications

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“…Multiple comparative reviews have failed to demonstrate a consistent difference in outcomes with either technique compared with the other. [395][396][397][398][399][400][401][402][403][404][405] One report involved a single experienced surgeon and a series of patients who required staged bilateral CEA in whom 1 side was randomly allocated to primary closure and the other side to patch angioplasty. 406 Patch angioplasty was associated with lower 30-day surgical morbidity and mortality and fewer cases of residual or recurrent stenosis as assessed by periodic duplex scanning for up to 1 year postoperatively.…”

Section: Technical Considerationsmentioning

confidence: 99%

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

Brott¹,

Halperin²,

Abbara

et al. 2011

Stroke

143

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Section: Technical Considerationsmentioning

confidence: 99%

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

Brott¹,

Halperin²,

Abbara

et al. 2011

Stroke

143

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“…Experimental evidence comparing repair of a canine common carotid artery with primary closure, a 5mm patch or a 10mm patch demonstrated different geometry and more disturbed haemodynamics with the larger patch 9 . This may cause flow recirculation and platelet aggregation, 18 which may result in peri-operative embolic events and occlusion as well as contributing to late restenosis through neointimal hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is no detailed information on the indications for patch angioplasty, nor the patch material or size. Experimental evidence has suggested that patch width affects geometry and haemodynamics following surgery, which may influence clinical outcomes 9,10 . The aim of this questionnaire-based study was to further explore the indications and techniques of patching after CEA adopted by vascular surgeons across Great Britain and Ireland.…”

mentioning

confidence: 99%

Patch variability following carotid endarterectomy: a survey of Great Britain and Ireland

Harrison

Brennan²,

Naik³

et al. 2012

Ann R Coll Surg Engl

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INTRODUCTIONEvidence 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.METHODSAn 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.RESULTSThere 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: 8mm, range: 4–10mm). Fourteen (12%) variably trimmed the patch (median: 7.5mm, range: 5–10mm) and 34 (28%) routinely trimmed (median: 6mm, range: 3–20mm). Selective patching, dependent on internal carotid artery diameter, was performed by 48 respondents (26%), 23 of whom specified a median artery threshold diameter of 5mm (range: 3–8mm). 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).CONCLUSIONSThere 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.

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“…The advantage of patch closure is visual confirmation of complete plaque removal, but the disadvantage is the greater length of time required for closure. Multiple comparative reviews have failed to demonstrate a consistent difference in outcomes with either technique compared with the other (395)(396)(397)(398)(399)(400)(401)(402)(403)(404)(405). One report involved a single experienced surgeon and a series of patients who required staged bilateral CEA in whom 1 side was randomly allocated to primary closure and the other side to patch angioplasty (406).…”

Section: Technical Considerationsmentioning

confidence: 98%

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

Brott¹,

Halperin²,

Abbara

et al. 2011

Journal of the American College of Cardiology

286

120

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Hemodynamic Effects of Primary Closure Versus Patch Angioplasty of the Carotid Artery

Cited by 27 publications

References 20 publications

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

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

Patch variability following carotid endarterectomy: a survey of Great Britain and Ireland

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

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