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Minerva Cardiology and Angiology 2021 Sep 02

DOI: 10.23736/S2724-5683.21.05685-4


lingua: Inglese

Carotid endarterectomy with saphenous vein patch angioplasty in a single-centre experience

Andrea ESPOSITO, Danilo MENNA , Angela BAIANO, Pietro BENEDETTO, Ferdinando DI LEO, Antonio TRANI, Antonino P. CAPPIELLO

Vascular Surgery Division, Cardiovascular Department, San Carlo Hospital, Potenza, Italy


BACKGROUND: When performing a conventional CEA it is recommended the use of patch angioplasty (PA), since previous meta-analyses have shown PA to be superior to primary closure (PRC) in terms of stroke and restenosis rates. Different materials patches can be employed although none of them has been proved to be superior. Although autologous veins are potentially more resistant to immediate thrombosis as well as infection, cons may be represented by patch rupture and late dilatation. Aim of this study is to evaluate immediate and long-term results of CEA with saphenous vein patch angioplasty (SVPA) in a single-centre experience.
METHODS: A retrospective study was performed analyzing all patients undergoing CEA with SVPA at our institution from January 2012 to March 2020. CEA was performed in symptomatic patients with 50-99% carotid stenosis degree or asymptomatic patients with 70-99% stenosis degree. Exclusion criteria were critical limb ischemia, varicose disease, unavailability of saphenous veins, vein diameter <3,5mm. All CEAs were performed under general anesthaesia with routine shunting. Primary endpoints were perioperative stroke, death, carotid thrombosis and haematoma requiring surgery rates. Secondary endpoints included the rate of recurrent stenosis >70%, patch aneurysm/rupture/infection at follow-up.
RESULTS: Four-hundred-eighty-eight interventions were performed on 461 patients. Most patients were male (77,8%) with a mean age of 71,2±8,3 years. 30-day mortality and stroke rates were 0,4% and 1,2% respectively. Carotid thrombosis occurred in 5 patients (1%). Five patients (1%) developed a surgical site hematoma requiring surgical drainage. At a mean follow-up of 34,4±25,8 months 12 restenoses (2,5%) were detected. Five-year freedom from restenosis rate was 96,7%. Restenosis at follow-up was more frequent in patients who had contralateral carotid stenosis (p=.019). Two patients (0,4%) developed carotid patch aneurysmal degeneration at a mean follow-up of 78,7 months. No infection nor patch disruption were detected.
CONCLUSIONS: CEA with SVPA resulted safe end effective in terms of early and late results. The perioperative complications rates we recorded were quite similar to those reported by other larger reviews and meta-analyses.

KEY WORDS: Carotid endarterectomy; Patch angioplasty; Saphenous vein; Stroke; Restenosis

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