Is there carotid artery aneurysm formation following saphenous vein patch endarterectomy?

The use of saphenous vein patching following carotid endarterectomy is repo rted to produce aneurysmal dilatation with the risk of thrombosis and possi ble rupture, The authors have studied patients who have had saphenous vein patch angioplasty following carotid endarterectomy to assess whether there is any progressive arterial dilatation, Thirty-five patients who had underg one saphenous vein patch carotid endarterectomy were age- and sex-matched w ith 31 subjects that had direct closure endarterectomy, All participants un derwent carotid duplex scanning. The external diameters of the mid common c arotid artery, the bulb and the proximal internal carotid artery were measu red bilaterally. The diameters of the endarterectomized carotid were compar ed with the contralateral side using a paired t-test. Using an unpaired t-t est, the saphenous vein angioplasty group was compared with the directly cl osed group. A graph was plotted of the ratio of internal carotid artery dia meter of the saphenous vein angioplasty group (endarterectomized artery to the contralateral artery) against the length of follow-up, and the Pearson correlation coefficient was calculated. When the saphenous vein angioplasty group was compared with the directly closed group there was a significant difference between the carotid bulb (11.6 versus 9.7 mm, P < 0.001) and int ernal carotid artery diameters (9.0 versus 7.0 mm, P < 0.001). Longitudinal analysis of the saphenous vein angioplasty group showed that the increased diameter of the endarterectomized internal carotid artery progressed with time after surgery (r = 0.51, P < 0.005, and r = 0.56, P < 0.001). Vein pat ching increases the diameter of the internal carotid artery, and this may f urther increase with time possibly predisposing to aneurysm formation. Furt her longitudinal studies of paired data are required. (C) 2000 Published by Elsevier Science Ltd. All rights reserved.