EARLY AND LATE RESULTS OF BIOSYNTHETIC OVINE CAROTID ANGIOPLASTY

Recent major technical improvements in the field of carotid surgery ha ve been related to anesthesiology and cerebral monitoring. However ear ly embolic events and recurrent stenosis are, after intraoperative isc haemia, the main problems of carotid endarterectomy (CEA) and therefor e technical improvements that reduce the incidence of these complicati ons are required. The choice between primary closure and angioplasty i s still debated. In the case of angioplasty, the choice of patching ma terial seems to be important in preventing these complications. The Au thors present their experience with a biosynthetic ovine patch in caro tid surgery. In the period from January 1982 to November 1991, 1013 ca rotid endarterectomies were performed on 866 patients (659 men, 207 wo men) with atherosclerotic disease at the carotid bifurcation. In 147 c ases a bilateral CEA was performed. Recently, in 37 cases of patch ang ioplasty, the Authors used the biosynthetic ovine patch. No deaths and no permanent neurological deficit were registered in this series eith er during awakening or the immediate postoperative period. Of these 37 patients, all except 4, had a minimum follow-up of 24 months. Two cas es of non-hemodynamic restenosis were detected, one at 6 and one at 12 months; both were asymptomatic. In this series the total restenosis r atio was 5.5% (2/36), and the cumulative mortality rate 10.8% (4/37) ( IMA 2, hepatic insufficiency 1, cerebral hemorrhage 1). The Authors' p reliminary experience with this biosynthetic graft as a patching mater ial has been satisfactory. They believe that this biosynthetic graft ( Omniflow) on account of its handling and particularly its healing char acteristics can be considered as a graft material for patching at the carotid level.