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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)
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.
language: English, Italian