ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 1998 March;5(1):21-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English, Italian

Bovine pericardium patch angioplasty in carotid surgery

D’Addato M., Tealdi D., Curti T., Casana R., Cirelli M. R.

From the Department and Unit of Vascular Surgery Policlinico Sant’Orsola-Malpighi, Bologna, University of Bologna, Bologna, Italy * Department and Unit of Vascular Surgery Hospital San Donato, Milan, University of Milan, Milan, Italy

Background. Carotid endar­te­rec­to­my (CEA) ­remains the treat­ment of ­choice for ste­nos­ing carot­id ­lesions to pre­vent ­stroke in symp­to­mat­ic ­patients. A ­much debat­ed sub­ject, on ­which ­there is con­flict­ing evi­dence, is the appli­ca­tion of a wid­en­ing ­patch as ­opposed to sim­ple CEA to pre­vent resten­o­sis.
Methods. From September 1994 to June 1997 we per­formed a pros­pec­tive ­study on 77 ­patients (46 men, 31 wom­en) who ­received a ­bovine per­i­car­di­um ­patch (5 bilat­er­al). History-tak­ing dis­closed TIA in 27 ­patients (35%) and ­stroke in 7 (9%); the remain­ing 43 ­patients (56%) ­were asymp­to­mat­ic. Follow-up mon­i­tor­ing of 58 last­ed 12 ­months and com­prised ­colour Doppler ultra­so­nog­ra­phy of ­blood ­flow and arte­ri­al ­wall mor­phol­o­gy.
Results. At fol­low-up 52 ­patients (67.5%) pre­sent­ed ­mild sten­o­sis (i.e. ­less ­than 20%), ­four (5%) had mod­er­ate sten­o­sis, one ­patient (1.3%) ­severe sten­o­sis (i.e. ­more ­than 75%) requir­ing ­redo sur­gery, and one (1.3%) pre­sent­ed ­post-CEA ecta­sia con­trolled by ­colour Doppler ultra­so­nog­ra­phy. In com­par­i­son ­with pros­the­ses ­made ­from syn­thet­ic poly­mers, ­such as Dacron and ­PTFE, ­bovine per­i­car­di­um ­appears to be cheap­er. This bio­log­i­cal mate­ri­al ­also has the advan­tage of avoid­ing hem­or­rhage at the punc­ture ­site and is strong­er ­than Dacron.
Conclusions. Bovine per­i­car­di­um is a val­id mate­ri­al for sur­gi­cal ­patch appli­ca­tion in the carot­id ­artery.