SAPHENOUS-VEIN BYPASS - AN ALTERNATIVE TO INTERNAL CAROTID RECONSTRUCTION

Objective: Venous grafting is rarely employed for carotid reconstructi on,. the aim of this retrospective study was to assess its value as an alternative to endarterectomy. Material: Between January 1980 and Jun e 1990, we performed 212 carotid artery venous bypasses (CVB) on 208 p atients. Twenty-nine patients were asymptomatic, 60 had non-hemispheri c symptoms and 119 focal symptoms. The indication for surgery was sten osis in 185 cases, kinking in 18 and aneurysms in nine. The main crite ria to use CVB were length of the lesion in 86 cases, extent of athero sclerosis in 75, dysplasia in 12, intraoperative failure of endarterec tomy in 21, aneurysms in seven and long-term restenosis or occlusion i n 12. Results: There were 11 deaths, three strokes and nine transient ischaemic attacks. Angiographic control showed one occlusion giving an immediate patency rate of 99.5%. Mean follow-up was 104.3 +/- 46.1 mo nths with 15 patients lost to follow-up. Eighty patients died; life ex pectancy was 52.4 +/- 7.5 at 10 years. Including occlusions and resten osis as failures, the secondary patency rate was 96.4 +/- 3.7 at 10 ye ars. The annual stroke rate was 1.3% and the neurologic event-free-pop ulation 87 +/- 2.4% at 10 years. Conclusion: CVB is a valuable alterna tive to endarterectomy for reconstruction of the carotid artery. The i ndications are extensive atherosclerosis involving the common carotid artery, intraoperative anatomic failure of endarterectomy, and longter m restenosis.