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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 Dicembre;13(4):173-6
Carotid endarterectomy with patch angioplasty: internal carotid tortuosity does not affect restenosis
Losa S. 1,2, Vitiello R. 1,2, Martelli M. 1,2, Senatore S. 1,2, Gabrielli L. 1,2
1 Department of Vascular Surgery Policlinico MultiMedica–S.S.Giovanni, Milan, Italy
2 Department of Vascular Surgery University of Milan, Milan, Italy
Aim. In carotid stenosis indicated for surgery, eversion endarterectomy is proposed to repair tortuous internal carotid arteries. In contrast, conventional endarterectomy with Dacron patch angioplasty may accentuate the angulation of the tip of the patch, especially if the arteriotomy is extended distally on the internal carotid artery. This angulation induces turbulence that alters shear stress, causing potential myointimal hyperplasia and early vessel restenosis. The aim of this study was to evaluate the incidence of restenosis in a series of patients with carotid stenosis treated with endarterectomy and Dacron patch angioplasty.
Methods. A total of 66 carotid stenoses were treated. Follow-up controls using echo color Doppler sonography were performed on postoperative day 2, and then at 2, 6, 12, and 18 months. Parameters evaluated were the angle between the axis of the bifurcation and the internal carotid with the vertex at the tip of the patch, as well as peak systolic volume (PSV) and end diastolic volume (EDV) on the downstream internal carotid.
Results. At a mean follow-up of 14 months, significant remodeling with reduced progression of the acquired angulation was observed in 39 procedures with a postoperative angle of between 135° and 160° (group 1); no significant alterations were detected in 10 procedures with an angle of between 105° and 135° (group 2) or in 17 procedures with an angle >160° (group 3). In all three groups, the reduction in PSV and EDV was statistically significant at follow-up compared with postoperative values; no restenosis was observed.
Conclusion. Carotid endarterectomy with patch angioplasty was found to be a technique that can be adapted to a carotid axis with accentuated and permanent tortuosity. No restenosis was observed during the 14-month follow-up period.