The Influence of Collagen Impregnation of a Knitted Dacron Patch Used in Carotid Endarterectomy

Abstract

In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a polytetrafluorethylene patch. There is concern that collagen impregnation may initiate thrombosis or promote restenosis due to platelet activation. We performed a retrospective analysis of our CEA experience with routine patching using knitted Dacron patches with (Hemashield) and without (Sauvage) collagen impregnation. Our database was queried for all CEAs between January 2006 and December 2010. Seven surgeons performed 655 CEAs. Patients were excluded if no patch was used (n=1), a primary CEA was performed before study period or by other surgeons (n=11), or the patch type was indeterminable (n=38). Demographics, clinical data, and outcomes were compared between the collagen-impregnated (C, Hemashield) group and non-collagen-impregnated (NC, Sauvage) group. A total of 605 CEAs were analyzed (395 C and 210 NC). Demographics were similar except for coronary artery disease (C 54.3% vs. NC 41.6%, P=0.003). There was no statistically significant difference in 30-day (C 99.7% vs. NC 99.5%, P>0.99) or 5-year survival (C 80.0% vs. NC 83.7%, P=0.26) or 30-day stroke rate (C 0.3% vs. NC 1.0%, P=0.28). No late ipsilateral strokes occurred during 5-year follow-up. The 5-year freedom from restenosis >30% (C 85.3% vs. NC 86.4%, P=0.33), restenosis >50% (C 94.5% vs. NC 95.5%, P=0.44), and restenosis >70% (C 98.6% vs. NC 98.9%, P=0.73) were similar. Two patients underwent carotid stenting for restenosis >70%. Two patients (both in the C group) developed occlusion of the carotid artery. The thrombosis and restenosis rates in the 2 groups were similar. This suggests that collagen-impregnated patches do not initiate thrombosis or increase restenosis rates after CEA.