Decreased recurrent carotid stenosis by routine patching and intraoperative scanning

Our objective was to review the results of carotid endarterectomies (CEAs) with Dacron patch angioplasty and intraoperative color-flow duplex scanning (CFS). In a S-year period, patients who underwent CEA with Dacron patch an gioplasty and intraoperative CFS were studied. We excluded patients who had primary closure, vein patch, and redo endarterectomy. Serial CFS was obtai ned first in the early postoperative period tone day to 3 weeks), then at 6 months, and then yearly. Intraoperative CFS abnormalities were classified as major, requiring immediate revision, or minor, which were observed. The diagnosis of recurrent stenosis by US was based on the detection of an incr eased peak systolic frequency (>8000 MHz) or velocity (>250 cm/second) in t he internal carotid artery. There were 212 CEAs performed in 200 patients ( 128 men and 84 women) included in this study. Three patients (1.4%) awoke w ith a stroke, two (0.94%) had transient ischemic attacks, and three (1.4%) developed transient hypoglossal nerve paresis. Intraoperative CFS showed a major defect that required an immediate revision in six patients (2.8%), Mi nor abnormalities were detected in another 41 patients (19.3%), but no revi sion was necessary. In follow-up three patients were identified with a seve re recurrent carotid stenosis (>80%) and they underwent redo CEA. This rate of recurrence (1.4%) is significantly lower than the rate we had previousl y reported in a larger study (82 of 1209, 6.8%; P = 0.003). We conclude tha t the combined use of Dacron patch angioplasty and intraoperative CFS after CEA is associated with a low perioperative morbidity and a low incidence o f recurrent stenosis in the first 2 years after operation.