CAROTID ENDARTERECTOMY WITH HOMOLOGOUS VEIN PATCH ANGIOPLASTY - A REVIEW OF 1006 CASES

Purpose: Because homologous vein is rarely used in vascular reconstruc tions, we evaluated the homologous vein as a patch for the reconstruct ion of the carotid bifurcation after endarterectomy. Methods: Excess v ein harvested during open heart operations was either refrigerated in saline solution or cryopreserved in a solution of 10% dimethyl sulfoxi de. Donors were tested for transmissible infections, and the veins wer e cultured for common pathogens. Data were analyzed from 837 consecuti ve patients (1006 cases) who underwent carotid endarterectomy with hom ologous vein patch angioplasty between 1981 and 1993. Results: The per ioperative mortality rate was 0.8% (eight patients). Two deaths (0.2%) were attributed to ipsilateral strokes. Ischemic strokes occurred in 12 patients (1.2%; 10 ipsilateral), and ipsilateral transient ischemic attacks occurred in three patients (0.3%). Follow-up data were obtain ed for 482 patients (56%; mean follow-up time, 61 months; range, 1 to 132 months). Ipsilateral recurrent symptoms occurred in eight patients (1.7%; seven strokes, one transient ischemic attack). Of the 63 late deaths (13%), the majority (25 patients; 40%) were caused by complicat ions of coronary artery disease. The 10-year overall survival rate was 76% +/- 3.2%, and the 10-year rate of freedom from late ipsilateral m orbidity was 96% +/- 1.4%. The 10-year rate of freedom from late steno sis (a reduction in diameter of greater than or equal to 20%) in the 2 20 arteries (22%) that were studied by duplex scan was 84% +/- 2.3%. C onclusions: The postoperative mortality and neurologic morbidity rates of carotid endarterectomy with homologous vein patch angioplasty are similar to those in the best series with all types of closure. The exi sting long-term follow-up data indicate that the homologous vein is a durable patch that behaves like other patches used in the same locatio n.