CAROTID-ARTERY SURGERY - VENOUS GRAFT

Thromboendarterectomy is the most popular technique of carotid restora tion for atheromatous lesions. In some cases, endarterectomy may be di fficult or hazardous to perform, when atherosclerotic lesions involve the proximal common carotid artery and/or the distal internal carotid artery, when they are radiation induced, and when they are associated with fibromuscular dysplasia, loops or kinking. In other cases, result of endarterectomy may be unsatisfactory, because of a traumatic lesio n of the arterial wall during endarterectomy, or a stenosis of the art eriotomy closure. Postoperative and late restenosis and occlusion rate range between 10 and 50% after primary closure of the carotid arterio tomy. Some of these complications may be reduced by alternative techni ques such as eversion endarterectomy or patch angioplasty closure. Rev ersed saphenous bypass may also be performed. In our experience, only suitable autologous greater saphenous vein shall be harvested, includi ng adequate length, absence of valves, diameter greater than 4 mm, and excellent wall texture. Distal anastomosis on the internal carotid ar tery shall be performed end-to-side with ligation of the internal caro tid stump, and not end-to-end. Thus, in that location, venous grafts h ave excellent longterm patency with less than 5% late restenosis or oc clusion rate. Thus, venous graft bypass may be an alternative techniqu e to carotid endarterectomy, especially in young patients and women, w ho are more often exposed to late complications.