CAROTID REPLACEMENT GRAFTS FOR EXTRACRANIAL ATHEROSCLEROTIC DISEASE

Carotid artery reconstruction using interposition grafts is usually in dicated for management of recurrent stenosis where endarterectomy cann ot be performed, where quality of the carotid artery is unsatisfactory following endarterectomy, or where there are aneurysmal changes in th e artery. The purpose of this study was to evaluate the perioperative and long-term results in patients who underwent carotid replacement gr afts. The authors conducted a retrospective chart review of 758 operat ions performed for extracranial carotid disease between August 1987 an d February 1995. In 10 of these cases, the quality of the carotid arte ry following endarterectomy was so thin or had such an irregular surfa ce that replacement grafts were necessary. In three of these 10 patien ts, surgery had been performed for recurrent carotid stenosis. Autogen ous vein was utilized in seven cases, and prosthetic material was used in three cases (polytetrafluoroethylene [PTFE] in two cases and Dacro n in one case). Follow-up was complete in all patients and ranged from 16 to 87 months (mean, 47 months). Serial duplex scans were performed in all cases. All grafts remained patent, but duplex scanning detecte d severe stenosis in two of the 10 grafts at 7 and 39 months, respecti vely, after the initial reconstruction. In both cases, contrast angiog raphy confirmed the findings. In both patients, the areas of stenosis occurred in the midportion of a reversed vein graft at a valve site. T he stenoses were corrected without further restenosis. There were no p ostoperative stenoses in the three cases where prosthetic material was used. There were no early or late strokes or deaths. The late seconda ry patency of carotid artery replacement grafts is excellent. Intraope rative detection and ablation of venous valves or choosing a vein segm ent without valves when autologous grafts are used may decrease the in cidence of secondary stenosis. Serial duplex scanning is recommended f or both short-term and long-term follow-up.