CAROTID ENDARTERECTOMY: PRIMARY CLOSURE VERSUS PATCH ANGIOPLASTY

M.Saad, Ehab; Sharaf, Hesham; Abd El-Latif, Atif; Mowafy, Khalid; Al-Mongy, Azza

doi:10.21608/ejsur.2003.374707

CAROTID ENDARTERECTOMY: PRIMARY CLOSURE VERSUS PATCH ANGIOPLASTY

Document Type : Original Article

Authors

¹ Vascular Surgery Unit, Department Of General Surgery, Mansoura Faculty of Medicine

² Department Of Neurology, Mansoura Faculty of Medicine

10.21608/ejsur.2003.374707

Abstract

Objective: Carotid endarterectomy closure remains controversial.The aim of this work is a comparative study between
primary closure and patch angioplasty after carotid endarterectomy as regard recurrent stenosis,recurrent stroke,and other operative complication.
Patients and methods: Forty Five patients with symptoms and signs suggestive of carotid artery occlusiove disease were admitted, investigated, treated and followed up in vascular surgery unit and neurology department of Mansoura University Hospital during the period from August 1998 to April 2002. Only twenty patients (Out of Forty five) fulfilling the criteria of surgical interference of carotid endarterectomy (CEA) with other twenty-five patients excluded from the study. They were divided into two main groups: group I CEA with primary closure (10 patients). Group II CEA with patch closure (10 patients, 5 saphenous vein patch, and 5 PTEE patch). Life table analysis was used to compare recurrent stenosis(>50%),recurrent stroke and other postperative complication for each group.
Results: No perioperative stroke or mortality in both groups. Life table analysis for patency rate (recurrent stenosis free rate) showed stenosis free rate 100% at 18 months and 50% after three years for primary closure group, and it was 100% free till 18 months and 85.7% after three years for patch closure group. Comparison between the two groups using the log rank test showed no significant difference (P= 0.45). Stroke free rate at three years was 80% in patients in whom primary closure was done, and 85.7% in patients in whom patch closure was done (p=O.51 ).
Conclusion: In patients with occlusive carotid artery disease, it is advised to do patching after endarterectomy rather than to do simple closure. This procedure give better results as there is less incidence of post operative recurrent stenosis and/or thrombosis, also there is less incidence of recurrent stroke on long term follow up. Saphenous vein patch gives better results compared to PTFE patch on log term follow up.

Keywords