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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2006 March;13(1):5-9
Carotid bypass in extensive lesions of the common and internal carotid artery
Mandolfino T., Canciglia A., D’Alfonso M., Carmignani A., Spinelli F.
Postgraduate School of Vascular Surgery University of Messina, Messina, Italy
Aim. Carotid endarterectomy (CEA) is the procedure of choice in carotid stenosis. Reconstruction of the internal carotid artery due to tumor, recurrent or extensive disease may be necessary. The aim of this retrospective study was to evaluate the short and long term results with carotid bypass for carotid repair.
Methods. From 1997 to 2002, we performed 96 carotid bypasses. Ninety-three had focal symptoms, 3 were asymptomatic. The indications for carotid bypass were: an extended atherosclerosis disease in 71 cases, inadequate end-point during CEA in 13, dysplasia in 4, restenosis after CEA in 4, restenosis after angioplasty and stenting in 2, aneurysm in 2. Sixty-two procedures were venous and 34 used polytetrafluoethylene prosthesis.
Results. There were 2 deaths within 30 days in the vein group. In this group mortality was 3.2% and the overall mortality 2%. Two patients were lost during the follow-up, which used clinical and Duplex scan surveillance at 1-72 months (mean 24 months). Two bypasses were occluded, 3 had restenosis (4.8%) in the vein group. One bypass was occluded and 2 had restenosis (5.8%) in the prosthetic group. Eleven patients died. The cumulative primary and secondary patency rate was 90.9%±6.4% and 94.4%±5.1% at 5 years. The cumulative survival rate was 85.4%±7.4% at 5 years. Stroke free rate was 94.2%±5.2% at 5 years.
Conclusion. Carotid artery bypass grafting can be effective for the reconstruction of internal carotid artery in extensive atherosclerotic lesions and restenosis. Although the long term risks of stroke, occlusion and recurrent stenosis are low, long term surveillance is necessary.