Influence of vein-patch angioplasty on carotid endarterectomy healing
G. W. Stewart, D. F. Bandyk, H. W. Kaebnick, J. D. Storey and J. B. Towne
We studied the influence of venous patching on the patency, endothelial
regeneration, and wall healing of endarterectomized carotid arteries in a
canine model. Thirteen dogs underwent bilateral common carotid
endarterectomies (intimectomy and partial media excision). In each dog, one
artery was closed by continuous suture and the contralateral artery was
closed by external jugular vein-patch angioplasty; arteries were excised at
two postoperative intervals (two to three and four to five weeks) for
light, scanning, and transmission electron microscopy. The patency of
arteries closed primarily (9/13 [69%]) was not significantly different
compared with arteries closed with venous patches (12/13 [92%]). By
scanning electron microscopy, regeneration of the endothelial monolayer
occurred by migration from the endarterectomy end points and suture lines.
Despite survival of the vein-patch endothelium, the rate and pattern of
reendothelialization was not altered by venous patching. In both patched
and unpatched vessels, endothelial regeneration was incomplete at two to
three weeks and completed by four to five weeks. The histologic
characteristics of the endarterectomized arterial wall after operation were
also not influenced by the closure technique. In contrast with the healing
artery wall, vein-patch walls did not develop a thickened intima. Although
venous patching does not influence early patency, endothelial regeneration,
or wall healing after endarterectomy, vein-patch angioplasty does increase
vessel diameter and prevents the development of circumferential intimal
thickening, attributes that are beneficial in minimizing restenosis.
