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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 August;40(4):555-9

lingua: Inglese

Selective patch­ing in carot­id endar­te­rec­to­my. Is patch­ing ­always nec­es­sary?

Pappas D., Hines G. L., Yoonah Kim E.

From the Department of Thoracic and Cardiovascular Surgery, Winthrop-University Hospital, Mineola, New York, USA


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Background. The val­ue of carot­id patch­ing in carot­id endar­te­rec­to­my in achiev­ing low per­i­op­er­a­tive mor­bid­ity and ­long-­term free­dom ­from resten­o­sis is con­tro­ver­sial. We hypoth­e­sized ­that if ­large inter­nal carot­id arter­ies ­were ­closed pri­mar­i­ly and small­er arter­ies selec­tive­ly ­patched, ­there ­would be no dif­fer­ence in ear­ly or ­long-­term ­results ­between the two ­groups.
Methods. A ret­ro­spec­tive anal­y­sis of 133 carot­id endar­te­rec­to­mies per­formed by one sur­geon in a com­mu­nity teach­ing hos­pi­tal was per­formed to eval­u­ate a selec­tive ­approach to patch­ing vs pri­mary clo­sure. Primary clo­sure was per­formed if the arter­i­ot­o­my ­could be ­closed with­out ten­sion ­over a Javid ­shunt. Seventy-seven arter­ies under­went pri­mary clo­sure and 56 under­went patch­ing (Vein-14, ­PTFE-17, Dacron-25). Postoperative (>6 ­month) ­duplex ­scans ­were avail­able on 46/77 (60%) ­patients under­go­ing pri­mary clo­sure, and 33/56 (59%) of ­patients ­with ­patch ­repair.
Results. There ­were 2 per­i­op­er­a­tive neu­ro­log­ic def­i­cits, ­both in the ­patch ­group. Restenosis of ­equal or great­er ­than 50% at 11 ­months ­occurred in 5/46 (10.8%) of ­patients ­with pri­mary clo­sure and 2/34 ­patients (5.9%) ­with ­patch clo­sure (p=ns). No ­patient in ­either ­group had a ­late neu­ro­log­ic ­event or ­required a ­redo oper­a­tion.
Conclusions. Selective pri­mary clo­sure is not asso­ciat­ed ­with ­increased ­risk of per­i­op­er­a­tive neu­ro­log­ic ­events or sta­tis­ti­cal­ly sig­nif­i­cant evi­dence of ­late post­op­er­a­tive sten­o­sis if pri­mary clo­sure is per­formed in ­large inter­nal carot­id arter­ies.

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