LONG-TERM FOLLOW-UP OF PATIENTS UNDERGOING REOPERATION FOR RECURRENT CAROTID-ARTERY DISEASE

Purpose: We examined the perioperative course and long-term fate of in dividuals who required reoperation for recurrent carotid artery diseas e. Methods: The records of 2289 patients undergoing 2961 consecutive o perations during a 22-year period were reviewed. Forty-two patients (1 .8%) who underwent reoperations were studied. Forty-seven redo carotid artery reconstructions were performed on these 42 patients for neurol ogic symptoms or asymptomatic high-grade stenosis. Long-term follow-up was obtained on 41 of 42 patients (mean 54 months; range 9 to 202 mon ths). Results: The forty-seven reoperations consisted of endarterectom y with patch angioplasty (n = 36), saphenous vein or polytetrafluoroet hylene interposition graft (n = 7), or simply vein or polytetrafluoroe thylene patch angioplasty (n = 4). There were no perioperative strokes or deaths. Three patients had perioperative transient ischemic attack s and two had cranial nerve injuries. The incidence of late failure af ter secondary surgery was 19.5% (8/41 patients). These failures consis ted of one stroke, three transient ischemic attacks, and four asymptom atic occlusions. One tertiary carotid artery reconstruction was perfor med for a restenosis at the site of the secondary reconstruction. Cons lusion: The factors responsible for the high incidence of late failure s after secondary carotid artery reconstruction are unclear. Reoperati on for recurrent carotid artery disease appears less durable than prim ary carotid endarterectomy. Close postoperative surveillance is recomm ended after carotid artery reoperation.