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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2001 March;8(1):13-24

language: English, Italian

External jugular vein patch versus PTFE patch after carotid endarterectomy. A randomised prospective study

Grego F., Milite D., Cognolato D., Frigatti P., Morelli I., Bonvini S., Damiani N., Deriu G. P.

From the Clinic of Vascular Surgery University of Padua, Padua, Italy (Chair: Prof. G. P. Deriu)


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Background. The aim of ­this ran­dom­ised pros­pec­tive ­study was to eval­u­ate the rel­a­tive ­risks and advan­tag­es of ­using exter­nal jug­u­lar ­venous ­patch ­graft com­pared to ­PTFE ­patch in carot­id endar­te­rec­to­my.
Methods. Between 1 December 1996 and 31 March 1998, 58 ­patients under­go­ing carot­id endar­te­rec­to­my at the Vascular Surgery Clinic in Padua ­were ran­dom­ly ­assigned to two ­groups: 29 ­with exter­nal jug­u­lar ­venous ­patch (Group A), and 29 ­patients ­with ­PTFE ­patch (Group B). All oper­a­tions ­were per­formed ­under gen­er­al anes­the­sia ­with con­tin­u­ous EEG mon­i­tor­ing and rou­tine dilat­ed use of ­shunt. Every ­patient under­went a ­check-up and ­colour Doppler ultra­so­nog­ra­phy at 6 and 12 ­months. This meth­od was ­used to exam­ine ­both the pres­ence of myoin­ti­mal hyper­pla­sia and the inci­dence of resten­o­sis, as to ver­i­fy the pres­ence of dil­a­ta­tion. Neurological mor­tal­ity and ­minor and ­major ­short- and medi­um-­term neu­ro­log­i­cal mor­bid­ity ­were ­also eval­u­at­ed. The exclu­sion cri­te­ria for Group A includ­ed: an exter­nal jug­u­lar ­vein ­with insuf­fi­cient diam­e­ter and/or the pres­ence of col­lat­er­al branch­es.
Results. No mor­tal­ity or mor­bid­ity was report­ed in ­both ­groups ­with ­regard to ­short-­term neu­ro­log­i­cal com­pli­ca­tions. Operating ­time and bleed­ing ­were sig­nif­i­cant­ly low­er in Group A ­patients. There was 1 ­case of post­op­er­a­tive mor­tal­ity (Group A), and 3 cas­es of ­long-­term mor­tal­ity (2 Group A and 1 Group B). We ­observed one ­case of throm­bo­sis ­with occlu­sion of the arte­ri­al ­axis (Group B) and a ­case of resten­o­sis (Group A) ­caused by myoin­ti­mal hyper­pla­sia ­that ­required ­redo sur­gery. No ­patch rup­tures ­occurred, or for­ma­tion of infect­ed ­false aneu­rysms in ­either ­group. One ­patient (Group B) under­went ­wound revi­sion fol­low­ing a later­o­cer­vi­cal hemat­o­ma on post­op­er­a­tive day 2.
Conclusions. Patch angio­plas­ty ­using exter­nal jug­u­lar ­vein com­pared to ­PTFE ­does not ­expose the ­patient to high­er ­risks and, ­when ­equal ­results are ­achieved, reduc­es bleed­ing and oper­at­ing ­times.

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