SAPHENOUS-VEIN VERSUS POLYTETRAFLUOROETHYLENE CAROTID PATCH ANGIOPLASTY

BACKGROUND: The optimal material for carotid patch angioplasty after e ndarterectomy remains uncertain, This study compares the early outcome and recurrent stenosis rates between saphenous vein (SV) and expanded polytetrafluoroethylene (ePTFE) carotid patch angioplasty, METHODS: T he results of 421 consecutive carotid endarterectomies performed over a 72-month period were reviewed. Postoperative complications and reste nosis rates, defined as greater than or equal to 60% narrowing measure d by color flow duplex, were compared. RESULTS: Patch angioplasty was performed with SV in 287 and with ePTFE in 110 cases. Patients who had undergone primary closure (n = 20) or whose form of closure was unkno wn (n = 4) were excluded. The mean age of patients and length of follo w-up was similar between groups. Women were more likely to be patched with ePTFE than were men (36% versus 23%, P = 0.02). One death occurre d in each group (0.3% SV, 0.9% ePTFE, P = 0.47), and four strokes occu rred in each group (1.4% SV, 3.6% ePTFE, P = 0.22), Cervical hematomas requiring operative evacuation occurred in five SV closures and in th ree ePTFE closures (1.7% versus 2.1%, P = 0.69). Vein harvest site com plications occurred in 6 patients (2%) who had undergone SV patch angi oplasty. Recurrent stenosis occurred in 3 patients with SV closure and in 3 patients with ePTFE closure (1.0% versus 2.7%, P = 0.35). The 60 -month restenosis rates by life table analysis were 2.6% +/- 2.1% for SV and 10.7% +/- 7.9% for ePTFE (P = 0.17). CONCLUSIONS: The incidence of postoperative complications is similar with SV or ePTFE patch angi oplasty; however, Vein harvest site complications are avoided with the use of ePTFE. Recurrent stenosis at 5 years occurs infrequently with either SV or ePTFE. (C) 1997 by Excerpta Medica Inc.