Reply

Abstract

The impact of vein patch angioplasty on the rate of restenosis after carotid endarterectomy has led to an increasing interest in vascular literature. Although most endarterectomies are performed with primary closure of the carotid artery, several studies have described that the use of venous patching significantly reduces the incidence of restenosis and occlusion. 1Archie JP Prevention of early restenosis and thrombosis occlusion after carotid endarterectomy by saphenous vein patch angioplasty.Stroke. 1986; 17: 901-905Crossref PubMed Scopus (107) Google Scholar, 2Ouriel K Green RM Clinical and technical factors influencing recurrent stenosis and occlusion after endarterectomy.J VASC SURG. 1987; 5: 702-706Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar, 3Hertzer NR Beven EG O'Hara PJ Krajewski LP A prospective study of vein patch angioplasty during carotid endarterectomy. Three-year result for 801 patients and 917 operations.Ann Surg. 1987; 206: 628-635Crossref PubMed Scopus (189) Google Scholar, 4Hans SS Girishkumar H Hans B Venous patch grafts and carotid endarterectomy.Arch Surg. 1987; 122: 1134-1138Crossref PubMed Scopus (22) Google Scholar, 5Deriu GP Ballota E Bonavina L et al.The rationale for patch-graft angioplasty after carotid endarterectomy: early and long-term follow-up.Stroke. 1984; 15: 972-979Crossref PubMed Scopus (111) Google Scholar, 6Katz MM, Jones Th, Degenhardt J, Gunn B, Wilson J, Katz S. The use of patch angioplasty to alter the incidence of carotid stenosis following thromboendarterectomy. J Cardiovasc Surg; 28:2–8.Google Scholar In our study on residual lesions and early recurrent stenosis7Sanders EACM Hoeneveld H Eikelboom BC Ludwig JW Vermeulen FEE Ackerstaff RGA Residual lesions and early recurrent stenosis after carotid endarterectomy.J VASC SURG. 1987; 5: 731-737Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar the impact of angioplasty could not properly be analyzed because more than 80% of the arteries were patched. Therefore we started a prospective randomized study in a consecutive series of 129 carotid endarterectomies,8Eikelboom BC Ackerstaff RGA Hoeneveld H et al.Benefits of carotid patching: A randomized study.J VASC SURG. 1988; 7: 240-247Abstract Full Text Full Text PDF PubMed Scopus (215) Google Scholar which were evaluated by duplex scanning at 3, 6, and 12 months. At 1 year, scanning was done in 105 arteries, and in 12 (11%) of these cases a restenosis of more than 50% diameter reduction was found. Ten of the 12 were in the primary closure group (21% restenosis) and two in the patch group (4% restenosis). This difference was statistically significant (p = 0.006). The rate of restenosis was especially reduced by venous patching in women. After these findings, in our institution venous patching is performed in most carotid endarterectomies. In a third study on the impact of venous angioplasty on long-term surgical outcome after carotid endarterectomy, 339 carotid arteries were examined by duplex scanning at yearly intervals over a period of 60 months. In this study we showed that especially during the first year after operation the rate of restenosis was significantly reduced by venous patching, both in female and male arteries. For both sexes the difference in the incidence of restenosis between patched and nonpatched arteries was highly significant (p < 0.0001, Fig. 1).This study also showed that recurrent stenosis more than 1 year after operation, which is thought to be due to recurrent atherosclerosis, was not influenced by venous patching. We sent this article to the editorial board of this journal, but unfortunately it was not accepted for publication.