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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 2002 June;9(2):115-23

language: English, Italian

Early thrombogenicity and preliminary results following FDP patch application after carotid endarterectomy

Pedrini L., Dondi M. *, Cirelli M. R., Magagnoli A., Magnoni F., Santoro M. *, Pisano E.

From the Ospedale Maggiore C. A. Pizzardi - Bologna Unità Operativa di Chirurgia Vascolare Dipartimento Chirurgico
* Unità Operativa di Medicina Nucleare Dipartimento di Diagnostica per Immagini


Background. The appli­ca­tion of an expand­ed ­patch ­after carot­id endar­te­rec­to­my (CEA) is rec­om­mend­ed to ­reduce the inci­dence of resten­o­sis. Most stud­ies ­report treat­ment ­with saph­e­nous or poly­tet­ra­flu­o­roe­thy­lene patch­es (­PTFE) ­because of throm­bo­gen­ic ­response to poly­es­ter. This ­study eval­u­ates the throm­bog­e­nic­ity of a poly­es­ter ­patch (FPD) pas­si­vat­ed by flu­o­rop­o­lym­er sur­face treat­ment ­which experi­men­tal stud­ies ­have dem­on­strat­ed as ­being ­less throm­bo­gen­ic ­than oth­er ­types of patch­es.
Methods. In ­this pros­pec­tive and ran­dom­ized ­study, 22 ­patients under­went CEA. Eleven ­received ­direct ­suture of the arter­i­ot­o­my, and 11 ­received an FPD ­patch. The ­patient’s 111Indium-­oxine ­labeled plate­lets ­were re-inject­ed on the ­first post­op­er­a­tive day and scin­tig­ra­phies ­were per­formed ­after 4, 24, and 48 ­hours.
Results. The ­results are report­ed as ­count ­ratio (CR) ­between the treat­ed and the con­tra­lat­er­al carot­id ­artery at 4, 24 and 48 ­hours. In the ­direct ­suture ­group, the CR was 1.07±0.09, 1.2±0.27, and 1.197±0.50, respec­tive­ly, where­as in the FPD-­patch ­group the CR was 0.96±0.04, 1.08±0.09 and 1.216±0.24, respec­tive­ly. A sta­tis­ti­cal­ly sig­nif­i­cant dif­fer­ence in plate­let adhe­sive­ness was ­found ­only on eval­u­a­tion at 4 ­hours. The rela­tion­ship ­between CR and pre­op­er­a­tive bleed­ing ­time was the ­only sta­tis­ti­cal­ly sig­nif­i­cant param­e­ter (r=0.5), ­which indi­cat­ed a cer­tain asso­ci­a­tion ­with the phar­mac­o­log­i­cal activ­ity of the ­antiplate­let ­drug admin­is­tered to the ­patients. At 6 ­months fol­low-up, 1 ­patient pre­sent­ed ­with resten­o­sis great­er ­than 60% and 1 ­patient ­with inti­mal hyper­pla­sia 2 mm ­thick. The ­patients had abnor­mal ­blood coag­u­la­tion val­ues, but no rela­tion­ship ­with com­mon ­risk fac­tors was ­found.
Conclusions. This ­study con­firmed ­that the FPD ­patch is no ­more throm­bo­gen­ic ­than a sim­ple CEA; there­fore, appli­ca­tion of the ­patch can be rec­om­mend­ed to ­reduce resten­o­sis with­out any add­ed throm­boem­bol­ic ­risk. The fea­sibil­ity of a mul­ti­cen­ter ­trial was con­firmed to ­show hypo­thet­i­cal dif­fer­enc­es ­between FPD-­induced carot­id throm­bog­e­nic­ity and ­long-­term ­results.

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