Long-term success of vein-patch and carotid endarterectomy

Abstract

Most patients with severe symptomatic carotid artery disease will benefit from a carotid endarterectomy to reduce the risk of a stroke. The long-term success of vein-patch angioplasty has been determined in this study. From 1974 to 1997, 507 patients had 587 carotid endarterectomies with a greater saphenous vein graft and 97 patients had 116 carotid endarterectomies with primary closure. Mean follow-up times were 3.6 and 3.7 years, respectively. Ten percent of the patients were followed for more than 10 years. Carotid duplex ultrasonography and/or angiography were used to determine patency. Graft occlusion or significant restenosis (>69%) of the carotid artery, and the occurrence of a stroke were determined. Life-table analyses of graft patency, stroke survival were done. Perioperative ipsilateral stroke rates were 0.5% and 2.6% with the vein patch graft and primary closure, respectively (p < 0.01). At 14 years, ipsilateral stroke-free rates were 97% for patients with a patch graft and 94% with primary closure (p < 0.001). The rates of freedom from restenosis were 94% with the patch graft and 70% with primary closure (p < 0.001), and primary patency rates were 96% and 81%, respectively (p < 0.002). Ipsilateral stroke-free survival rates were 52% and 37%, respectively for patients with a patch graft and primary closure (p < 0.02). Carotid endarterectomy with the vein-patch angioplasty gave an excellent result. The long-term patency of the graft and artery, freedom from an ipsilateral stroke, and survival were good. The results with a primary closure were inferior.