Venous patch grafts and carotid endarterectomy. A critical appraisal
S. S. Hans, H. Girishkumar and B. Hans
Division of Vascular Surgery, Detroit-Macomb Hospital Corp, MI.
Seventy-eight patients underwent 83 carotid endarterectomies (CEAs) with
vein patch grafts from 1980 to 1985. A technically satisfactory
endarterectomy was confirmed by completion arteriogram in all instances.
Indications for venous patch graft included a diameter of the internal
carotid artery of less than 3.0 mm (49 patients); an internal carotid
artery diameter of less than 3.5 mm, with contralateral internal carotid
artery occlusion (nine patients); unexpected stenosis detected by
completion arteriogram (six patients); a reexploration for neurologic
deficit following conventional CEA (three patients); and irregular surface
or edges of the endarterectomy site or high extension of a plaque (16
patients). Late follow-up arteriograms (66 studies) after a mean two-year
interval revealed three instances (4.5%) of recurrent asymptomatic
stenosis. Four patients (6%) developed late occlusions; three were
asymptomatic and one was associated with major stroke 2 1/2 years later.
One patient (1.5%) developed a false aneurysm. One patient experienced a
postoperative transient ischemic attack. There was no operative mortality.
Six patients died in the late follow-up period. The venous patch graft
ensured immediate patency of the internal carotid artery but failed to
prevent recurrent stenosis or occlusion in internal carotid arteries less
than 3.0 mm in diameter.
