J Korean Surg Soc.  2010 May;78(5):314-319. 10.4174/jkss.2010.78.5.314.

Comparison of Outcomes between Primary Closure vs. Patch Angioplasty in Carotid Endarterectomy

• Yun WS
• Kim DI
• Lee KB
• Park UJ
• Kim YW
• Kim GM
• Chung CS
• Bang OY
• Kim KH

• KMID: 2211958
• DOI: http://doi.org/10.4174/jkss.2010.78.5.314

Abstract

PURPOSE
The aim of this study was to compare the short and long-term outcomes following carotid endarterectomy (CEA) with either primary closure (PC) or patch angioplasty (PAT) performed by single center vascular surgeons.
METHODS
Between November 1994 and March 2008, a total of 366 patients underwent 401 consecutive primary CEA procedures at our institution. We retrospectively reviewed patients' medical records. Two vascular surgeons prefer routine PC and one vascular surgeon prefer routine patch closure using bovine pericardial patch. Postoperative neurologic complications were determined by clinical neurologists. Restenosis was defined as >50% stenosis on follow-up duplex scan. Data was analyzed to compare the early (< or =30 days) and late results of CEA between PC group and PAT group.
RESULTS
The mean follow-up duration was significantly longer in the PC group than that in the PAT group (61.7 months vs. 41.2 months, P<0.001). Coronary artery disease and combined CEA with coronary artery bypass were more common in the PAT group (39% vs. 55%, P<0.002; 4% vs. 12%, P<0.004). Perioperative ipsilateral TIA/stroke rates in the PC and PAT groups were 1.5% and 0.7% (PC=4/270 vs. PAT=1/131, P=0.564). Regarding late outcomes, Kaplan-Meier analysis failed to show any difference between 2 groups on freedom from ipsilateral transient ischemic attack (TIA)/stroke, freedom from restenosis and TIA/stroke-free survival (P=0.851, P=0.232, P=0.103, log-rank test).
CONCLUSION
Our results suggest that PC following CEA is not necessarily inferior to PAT for experienced surgeons.

Keyword

Carotid endarterectomy; Primary closure; Patch anigoplasty

MeSH Terms

Angioplasty
Constriction, Pathologic
Coronary Artery Bypass
Coronary Artery Disease
Endarterectomy, Carotid
Follow-Up Studies
Freedom
Humans
Ischemic Attack, Transient
Kaplan-Meier Estimate
Medical Records
Retrospective Studies

Figure

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  Fig. 1 Kaplan-Meier curves comparing freedom from ipsilateral TIA/stroke (A) and freedom from any TIA/stroke (B).

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  Fig. 2 Kaplan-Meier curves comparing freedom from restenosis (A) and TIA/stroke-free survival (B).

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