Cephalic Vein for Carotid Patching

Abstract

Objective To assess the effectiveness of cephalic vein patch (CVP) closure following carotid endarterectomy (CEA). Material and methods We reviewed 121 patients who underwent CEA using CVP closure. Patch-rupture, re-exploration, false aneurysm formation, re-stenosis requiring surgery, 30-day-mortality, donor site complications, stroke and TIA were noted. A small cohort of patients were reviewed at 5-years and rescanned. Results No patient suffered patch rupture or re-stenosis requiring surgery. One patient developed false aneurysm at 1 year but at the time of repair the patch was found to be intact. There were two cardiac deaths. Three patients suffered strokes of whom two made a full recovery. There were three cases of TIA. All wrist wounds healed primarily without complications. None of the 10 patients recalled for scanning at 5 years showed re-stenosis or late aneurysmal dilatation at the site of surgery. Conclusion Cephalic-vein can be harvested at the wrist without donor site complications and our experience shows it to be a convenient and safe means of closure following CEA. Compared to prosthetics it is cheaper and less susceptible to bacterial contamination. The use of CVP preserves leg veins for future cardio-vascular interventions. Long term function of CVP appears satisfactory.