Vein interposition grafting is a safe and durable method of repairing carotid arteries that are not suitable for standard endarterectomy

Abstract

Abstract Background Standard carotid endarterectomy (CEA) and patch angioplasty is an effective method of reducing the risk of stroke associated with carotid atherosclerosis. If the posterior wall of the carotid artery becomes excessively thinned following endarterectomy, or the vessel is exceptionally tortuous, this standard approach to repair is not always appropriate. A different approach may also be necessary when an existing carotid patch becomes infected. In a number of these cases the authors have utilized a vein interposition graft to repair the vessel. This study examined the safety and durability of this procedure. Methods During the 5-year study, a standard operative protocol was followed including routine shunting and peri-operative monitoring. All data were collected prospectively. Long saphenous vein harvested from the groin was used as a graft. Patients were entered into a regular duplex graft surveillance programme. Results Forty patients had a vein graft inserted (4·3 per cent of all CEAs performed). Age, sex and presentation were not significantly different from those in patients undergoing routine CEA. There were no vein graft ruptures or deaths. The 30-day any stroke or death rate was 5 per cent. The operation was not significantly lengthened relative to standard CEA. The median length of follow-up was 29 (range 4–48) months. Five patients required subsequent angioplasty to treat stenosis in the graft of more than 70 per cent; this is significantly higher than with standard CEA (P < 0·001). One patient developed an asymptomatic occlusion. At 1-year follow-up, 11 per cent of patients had a stenosis greater than 70 per cent, and at 2 years this was 6 per cent. Conclusion Interposition vein grafts can be used safely to repair the carotid artery when the standard technique does not appear appropriate. There is an increased rate of restenosis in this group and patients therefore require regular duplex surveillance of the graft.