Early and late outcome after carotid artery bypass grafting with saphenous vein.

Abstract

This study was undertaken to determine outcome and durability of internal carotid artery bypass grafting with saphenous vein. Data for 50 patients undergoing serial clinical and ultrasound surveillance were collected prospectively and analyzed retrospectively. Bypass grafting was performed in 50 patients between 1995 and 2002, the commonest reasons being excessive endarterectomy zone thinning or penetrating atheroma (n = 22), severe internal carotid artery coiling above the endarterectomy zone (n = 14), and patch infection (n = 5). Perioperative mortality was 2%, and death and stroke rate was 6%. Perioperative complications were associated with complex cardiovascular events, including hemorrhage after prosthetic patch infection, on-table thrombosis after endarterectomy, and synchronous carotid artery-cardiac reconstruction. One patient had a late ipsilateral stroke (10 months; normal scan). Cumulative stroke-free survival at 3 years (including operative events) was 91%. Cumulative freedom from recurrent stenosis greater than 70% or occlusion was 86% at 1 year and 83% at 3 years. Severe recurrent stenosis or occlusion developed in 7 patients, within 9 months of surgery in 6 patients and with 18 months in 1 patient. Angioplasty was performed without complication (no protection device, no stent) in 5 patients, 3 of whom required repeat angioplasty on at least one further occasion. In common with venous conduits elsewhere, carotid artery bypass grafting with saphenous vein is associated with a high incidence of early graft stenosis. The long-term stroke risk, however, is low. Carotid artery bypass grafting is a safe and durable alternative when endarterectomy would prove hazardous or inadvisable, but regular surveillance is necessary.