Interposition Graft Research Articles

Esthetics and bone changes of immediate implants with or without vascularized interpositional periosteal connective tissue grafting: A 2-year randomized controlled trial.

To compare esthetics at single immediately placed implants with and without soft tissue augmentation. Patients with non-restorable maxillary teeth in the esthetic zone were assigned into 2 groups: immediately placed implants with simultaneous vascularized interpositional periosteal connective tissue grafting (VIP-CTG) or non-grafted immediately placed implants (NG). The outcomes included: pink esthetic score (PES), gingival thickness, keratinized tissue width, buccal bone changes, marginal bone loss, pain, and satisfaction. Eighteen implants were included. At 2 years the mean value for PES was 12 ± 3.2 for the VIP-CTG and 12.9 ± 1.3 for the NG (p=.855). Mucosal thickness and keratinized tissue width showed no statistically significant difference between the two groups (p=.253) and (p=.931) respectively. Clinically buccal bone showed mean bone loss of 2.03 ± 1.57 mm for VIP-CTG and 1.09 ± 1.3 mm for NG (p=.247) and radiographically showed 1.67 ± 0.84 mm at the VIP-CTG and 1.16 ± 0.47 mm at the NG (p=.118). No statistically significant difference between both groups was demonstrated regarding marginal bone level changes (p=.142), pain (p=.622), or satisfaction (p=.562) at any time point. Simultaneous soft tissue grafting with immediate implant placement did not provide a more favorable outcome regarding esthetics or alveolar bone preservation effect. Undisturbed healing with the least surgical intervention seems to provide more favorable outcomes.

Aortic Injury From High-Speed Deceleration Against a Lap Belt in a 10-year-Old.

Traumatic aortic injuries in children and adolescents are rare, and even more rare are blunt traumatic injury to the abdominal aorta in this population. Therefore, there are few reports discussing the presentation and repair of such injuries, especially within the pediatric population. We report the successful repair of traumatic abdominal aortic transection in a 10-year-old female after a high speed MVC. She arrived in extremis with a seatbelt sign and was taken emergently for damage control laparotomy with subsequent postoperative CT findings of aortic transection/dissection at L3 with active extravasation. She immediately underwent open thrombectomy of the bilateral iliac arteries, and repair of her aortic injury with a 12 × 7mm Hemashield interposition graft extending just distal to the IMA and 1cm proximal to the aortic bifurcation. There are little data regarding long-term outcomes of pediatric patients undergoing different aortic repair techniques, and further research is needed.

Hybrid management of critical limb ischemia with a novel bioengineered vascular conduit.

A 61-year-old man presented with disabling short distance left lower extremity claudication. Surgical history was significant for an emergency laparotomy, bowel resection, temporary colostomy, external iliac artery ligation and right to left cross-femoral graft for damage control after a gunshot injury in 1982. This graft occluded a year later, and he underwent an ileo-femoral interposition graft. Progression of peripheral arterial occlusive disease (PAD) necessitated a left femoral endarterectomy with profundoplasty and superficial femoral artery stenting 20 years later.

Common femoral adventitial cystic disease in a young female patient

Adventitial cystic disease (ACD) is a rare condition that typically presents in young healthy men with symptoms of claudication. ACD is characterized by formation of a mucinous cyst within the adventitia of a blood vessel, usually in the popliteal artery, causing compression of the vessel's lumen and leading to reduced flow and symptoms of claudication. We have presented a rare case of ACD of the common femoral artery in a young female patient that was treated successfully with resection and femoral vein graft interposition reconstruction.

Vertical ridge augmentation of atrophic posterior mandible with corticocancellous onlay symphysis graft versus sandwich technique: clinical and radiographic analysis.

Alveolar ridge augmentation of atrophic posterior mandibular ridge represents a challenge in oral and maxillofacial surgery to restore aesthetic and function. The aim of the study was to compare the clinical and radiographic outcomes of bone formation in atrophic posterior mandibles augmented using onlay symphysis cortico-cancellous bone block with that augmented using sandwich bone augmentation technique (Inlay). Twelve patients were selected with missing mandibular posterior teeth. CBCT were done for all patients preoperatively to assess the residual bone height, ranged between 5 and 7mm from the inferior alveolar nerve with adequate sufficient alveolar ridge width more than 4mm. Patients required bone augmentation procedure with autologous onlay chin graft (group I) versus those used as inlay sandwich technique (group II). Clinical and radiographic analysis were done to analyses the newly formed bone and bone height. Percent of change in bone height was also calculated and revealed that group I was higher than group II, however, statistically insignificant differences between the two groups were found regarding the percentage of newly formed bone. Vertical ridge augmentation procedures using onlay chin graft took lesser time than the interpositional grafting with fixation technique, however, both techniques are promising for vertical ridge augmentation.

Hepatic venous reconstruction of the left lateral segment with emphasis on anomalous hepatic vein in pediatric liver transplantation.

Left lateral segment grafts have become a suitable option in pediatric liver transplantation (PLT). The correlation between hepatic vein (HV) reconstruction and outcome is relevant when assessing the safe use of these grafts. We retrospectively reviewed the medical records prospectively collected from a pediatric living donor liver transplantation database and conducted a comparative analysis of the different left lateral segment graft types according to HV reconstruction. Donor, recipient, and intraoperative variables were analyzed. Post-transplant outcomes included vascular complications such as hepatic vein outflow obstruction, early (≤30d) and late (>30d) PVT, hepatic artery thrombosis, and graft survival. From February 2017 to August 2021, 303 PLTs were performed. According to venous anatomy, the distribution of the left lateral segment was as follows: single HV (type I) in 174 (57.4%), close HVs, simple venoplasty for reconstruction (type II) in 97 (32.01%), anomalous hepatic vein (AHV) with a distance between the HVs orifices that allowed simple venoplasty (type IIIA) in 25 (8.26%) and AHV with a distance between the HVs orifices requiring homologous venous graft interposition (type IIIB) in 07 (2.31%) grafts. Type IIIB grafts came from male donors ( p =0.04) and had a higher mean donor height ( p =0.008), a higher mean graft weight, and a higher graft-to-recipient weight ratio, both p =0.002. The median follow-up time was 41.4 months. The overall cumulative graft survival was 96.3%, and comparative graft survival showed no difference (log-rank p =0.61). No hepatic vein outflow obstructions were observed in this cohort study. There was no statistically significant difference in the post-transplant outcomes between the graft types. The venous reconstruction of the AHV with homologous venous graft interposition had similar outcomes in the short and long term.

Complex Repair of Anomalous Left Coronary Artery From the Pulmonary Artery in a 55-Year-Old Patient.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a congenital malformation that classically presents within the first year of life. Few patients survive into adulthood, and initial presentation after the fourth decade of life is rare. We describe a 55-year-old woman who presented after cardiac arrest. She initially refused surgery and underwent automated implantable cardioverter defibrillator placement, followed later by surgical repair involving reimplantation of the left coronary artery to the aorta and pulmonary artery reconstruction using interposition grafts. We report this late presentation of ALCAPA and successful surgical management.

Staged autogenous to prosthetic hemodialysis access creation strategy to maximize forearm options

ObjectiveWhen an adequate cephalic vein is not available for fistula construction, surgeons often turn to basilic vein or prosthetic constructions. Single-stage forearm prosthetic hemodialysis accesses are associated with poor durability, and upper arm non-autogenous access options are often limited by axillary outflow failure, which inevitably drives transition to the contralateral arm or lower extremity. We hypothesized that initial creation of a modest flow proximal forearm arterial-venous anastomosis to dilate (“develop”) inflow and outflow vessels, followed by a planned second-stage procedure to create a cannulation zone with a prosthetic graft in the forearm, would result in reliable and durable hemodialysis access in patients with limited options. MethodsWe performed an institutional cohort study from 2017 to 2021 using a prospectively maintained database supplemented with adjudicated chart review. Patients without traditional autogenous hemodialysis access options in the forearm underwent an initial non-wrist arterial-venous anastomosis creation in the forearm as a first stage, followed by a second-stage interposition graft sewn to the existing inflow and venous outflow segments to create a useable cannulation zone in the forearm while leveraging vascular development. Outcomes included time from second-stage access creation to loss of primary and secondary patency, frequency of subsequent interventions, and perioperative complications. ResultsThe cohort included 23 patients; first-stage radial artery-based (74%) configurations were more common than brachial artery-based (26%). Mean age was 63 years (standard deviation, 14 years), and 65% were female. Median follow-up was 340 days (interquartile range [IQR], 169-701 days). Median time to cannulation from second-stage procedure was 28 days (IQR, 18-53 days). Primary, primary assisted, and secondary patency at 1 year was 16.7% (95% confidence interval [CI], 5.3%-45.8%), 34.6% (95% CI, 15.2%-66.2%), and 95.7% (95% CI, 81.3%-99.7%), respectively. Subsequent interventions occurred at a rate of 3.02 (IQR, 1.0-4.97) per person-year, with endovascular thrombectomy with or without angioplasty/stenting (70.9%) being the most common. There were no cases of steal syndrome. Infection occurred in two cases and were managed with antibiotics alone. ConclusionsFor patients without adequate distal autogenous access options, staged prosthetic graft placement in the forearm offers few short-term complications and excellent durability with active surveillance while strategically preserving the upper arm for future constructions.

Transfibular ankle arthrodesis with use of sagitally split fibula as a biological plate leads to excellent outcome: A retrospective analysis

BackgroundWe studied ankle arthrodesis with a transfibular approach using sagitally spilitted fibula as a biological plate (onlay grafting) as well as other half of fibula as morcellised local interpositional graft (inlay grafting) to achieve bony union. Material and methodsRetrospective clinico-radiological evaluation of 36 operated cases was done at 3, 6, 12 and 30 months follow-ups. Clinically union was considered once ankle became pain free on full weight bearing. Pain assessment was done by using VAS (visual analogue scale) score and functional evaluation was done by AOFAS (American Orthopaedic Foot & Ankle Society) hind foot score preoperatively and at different follow ups. Radiologically, sagittal plane ankle alignment and fusion status was determined at each follow up. ResultsMean age of patients was 40.36 ± 10.56 years (range 18–55), who were evaluated for mean duration of 33.32 ± 11.25 months (range 24–65). Thirty-three (91.7%) ankles were fused adequately and mean duration to achieve bony union was 5.09 ± 1.3 months (range 4–9 months). Mean post-operative AOFAS score at final follow up was 76.65 ± 4.87 in comparison to 45.76 ± 3.38, preoperatively. VAS score improved significantly from 7.8 (pre-operative) to 2.3 (final follow-up). Non-union in three patients (8.3%) and ankle malalignment in one patient was observed. ConclusionTransfibular ankle arthrodesis achieves excellent bony unions and functional outcomes in severe ankle arthritis. Biologically incompetent fibula that to be judged individually by the operating surgeon to use it as a graft. Patients having inflammatory arthritis have more dissatisfaction than other aetiologies.

‘Y’-Shaped Palmar Common Digital Artery Interposition Bypass in the Treatment of an Infantile M2 Large Aneurysm and Literature Review

Both craniotomy and interventional embolization are difficult and risky to treat complex middle cerebral artery (MCA) aneurysms in infants. Trapping with revascularization is a therapeutic option for giant aneurysms that cannot be clipped or coiled alone. We describe a technical method using revascularization with a natural Y-shaped palmar common digital artery interposition graft that provides a normal variation for a complex MCA aneurysm in an infant with intracerebral hemorrhage at 37 days of age. Conservative treatment was performed at that time. Seven months later, the patient was re-admitted to the hospital and was confirmed a large aneurysm in the M2 segment of the right MCA by cerebral angiography. A natural artery palmar common digital artery Y-graft was used as the graft and anastomosed to the M2 and both M3 trunks. The symptoms improved after surgery, and the mRS score of the patient was 1 after 5 years of follow-up. The palmar common digital artery can be an option for intracranial revascularization bypass in complex intracranial aneurysms.

Hook of the Hamate Pathologies and Associated Flexor Tendon Ruptures

Objective: Hook of the hamate pathology is an uncommon cause of spontaneous flexor tendon rupture. The purpose of this paper is to review the varying hamate pathologies leading to flexor tendon rupture, the incidence of each flexor tendon rupture, and the reported treatment options and outcomes of flexor tendon ruptures secondary to hook of the hamate pathology. Methods: A literature review was conducted using PubMed and Medline databases to obtain data on spontaneous flexor tendon ruptures associated with varying pathologies of the hook of the hamate. The search strategy included published articles in English with the terms “hamate” and “tendon rupture.” Combined searches yielded 42 abstracts. All papers were reviewed and evaluated. Twenty-four described flexor tendon rupture associated with hamate pathology. Studies were excluded if ruptures were not associated with hamate pathology confirmed intra-operatively. Results: Twenty-four manuscripts were identified that described the treatment of 66 patients with flexor tendon rupture secondary to hamate pathology. The small finger profundus tendon was ruptured in all 66 patients. Other tendon ruptures included: 32 small finger superficialis tendons (48%), 24 ring finger profundus tendons (36%), 9 ring finger superficialis tendons (14%), and 2 long finger profundus tendons (3%). 31 (46%) of the ruptures were associated with underlying hook of the hamate arthritis, 21 (32%) with hook of the hamate non-union, 9 (14%) with acute hook of the hamate fracture, and 5 with varying rare etiologies. Profundus ruptures were treated with either interpositional tendon grafting (52%), side-to-side profundus tenodesis (45%), or tendon lengthening with primary repair (3%). All tendon repairs were combined with hook of the hamate excision. All but one patient was reported to return to pre-injury activities following operative intervention. Conclusion: Hook of the hamate arthritis, fracture, and non-union are possible etiologies of spontaneous flexor tendon rupture and can cause significant morbidity if not recognized. Flexor tendon rupture secondary to hook of the hamate pathology appears to occur in a predictable fashion; small finger profundus → small finger superficialis → ring finger profundus → ring finger superficialis → long finger profundus. When healthy ruptured tendon ends can be identified, interpositional tendon grafting is an acceptable treatment option to treat flexor tendon ruptures secondary to hook of the hamate pathology. Otherwise, side-to-side profundus tenodesis provides sufficient repair for patients to return to pre-injury activities. Corresponding Author: Mitchell Gauger, [email protected], (574)-253-3321

Current trends in managing TMJ ankylosis in children-summing it up with a case report.

Temporomandibular joint (TMJ) ankylosis involves fusion of the mandibular condyle to the base of the skull. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. The experience of managing one such case is reported in light of a review of the literature on this condition. This report describes a case of a 7-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. Key management principles included adequate removal of the ankylotic mass, gap arthroplasty with interpositional temporalis myofascial grafting and post-operative physiotherapy. The patient maintains a satisfactory maximal incisal opening till the present day. A detailed history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy might be beneficial to restore physical, psychological and emotional health of the child patient with TMJ ankylosis.

Tuberoplasty: Indications, Technique, and Preliminary Results

The optimal approach to treatment of massive irreparable rotator cuff tears (MIRCTs) continues to be debated among shoulder surgeons. While nonsurgical treatment is a reasonable option for some, many of these patients continue to experience pain, weakness, and overall limited function of the shoulder [1], [2]. Superior capsular reconstruction has become a widely accepted approach to treatment of MIRCT, however there exists several technical and biologic challenges of this technique. Overcoming many of these difficulties, a recently described technique involves the placement of a biological interpositional graft over the greater tuberosity which acts as a permanent spacer between the humerus and acromion[3]. With the primary goal of providing pain relief, this technique may function to improve the benefit of rehab following MIRCT. In this article, we describe the indications, technique, and early outcomes of this so-called “tuberoplasty” approach to MIRCT.

Post-reconstruction Free Flap Complications After Oral Cancer Ablation.

Microvascular free flap transfer is considered a standard reconstruction after the ablation of oral cancer. Although the success rate is high, flap complications occasionally occur. This study investigated the reasons for and local factors involved in complications of free flap transfer and explored how to salvage the flaps. The cases of 53 patients who underwent a free flap transfer [radial forearm flaps (n = 36), abdominis musculocutaneous flaps (n = 6), scapular osteocutaneous flaps (n = 10), and fibular osteocutaneous flap (n = 1)] were analyzed: flap complications were observed in five of the cases. In the all five cases, a salvage operation was performed under general anesthesia. The flap complications occurred within 33h after anastomosis. In the salvage operation, thrombotic occlusion in veins of flap feeders was observed in three of the five cases. The possible reasons for flap complications were a twisting of the anastomosed vein where two veins were united, pressure to the feeder due to subcutaneous hematoma, and edema of adjacent tissue and/or drain tube; the reason was not clear in one case. The flaps were successfully salvaged in four cases by thrombectomy in veins, release of pressure at the veins, and/or interposition of the vein graft. Surgeons should pay close attention to the pressure and/or twisting in the feeder as well as the hemostasis in the surgical field, and a salvage operation should be carried out immediately when a flap complication is identified.

Facial Expression after Face Transplant: An International Face Transplant Cohort Comparison.

Assessment of motor function restoration following face transplant (FT) is difficult, as standardized, bilateral tests are lacking. This study aims to bolster support for software-based analysis through international collaboration. FaceReader (Noldus, Wageningen, The Netherlands), a facial expression analysis software, was used to analyze posttransplant videos of eight FT patients from Boston, Massachusetts (range, 1 to 9 years after transplant), two FT patients from Helsinki, Finland (range, 3 to 4 years after transplant), and three FT patients from Antalya, Turkey (range, 6.5 to 8.5 years after transplant). Age-matched healthy controls from respective countries had no history of prior facial procedures. Videos contained patients and controls performing facial expressions evaluated by software analysis using the Facial Action Coding System. Facial movements were assigned intensity score values between 0 (absent) and 1 (fully present). Maximum values were compared with respective healthy controls to calculate percentage restoration. Of 13 FT patients, eight patients were full FT, five patients were partial FT, and two patients were female patients. Compared with healthy controls, the median restoration of motor function was 36.9% (interquartile range, 28.8% to 52.9%) for all patients with FT ( P = 0.151). The median restoration of smile was 37.2% (interquartile range, 31.5% to 52.7%) for all patients with FT ( P = 0.065). When facial nerve coaptation was performed at the distal branch level, average motor function restoration was 42.7% ± 3.61% compared with 27.9% ± 6.71% at the proximal trunk coaptation level ( P = 0.032). Use of interpositional nerve grafts had no influence on motor outcomes. Software-based analysis is suitable to assess motor function after FT. International collaboration strengthens outcome data for FT. Therapeutic, IV.

Staged, Hybrid Repair Of Bilateral Common Femoral, Profunda, Superficial Femoral, And Popliteal Artery Aneurysms

We report a case of a 69-year-old man with asymptomatic aneurysms of the aorto-ilio-femoropopliteal arteries. CTA showed right side diameters of CFA 3 cm, SFA 2.1 cm, profunda 2.5 cm, popliteal 3.2 cm, and left side CFA 2.6 cm, SFA 2.1 cm, profunda 3.8 cm, popliteal 4.2 cm. Given risk of thrombo-embolic complications, extent of artery disease, and patient preference for limited open surgery, a staged, hybrid approach was utilized. He underwent left-sided bifurcated Dacron interposition graft from the EIA to the SFA and profunda with reimplantation of the largest profunda branch. A Viabahn stent was placed from the SFA anastomosis to P3, sized using IVUS. The right side was addressed seven weeks later with a shorter bifurcated interposition graft from the right EIA to SFA and profunda, with reimplantation of the largest profunda branch. Three branches of the profunda were embolized and a Viabahn stent placed from the profunda anastomosis to a distal target. The popliteal was stented from the SFA anastomosis to P3. Three months post-intervention the left profunda limb thrombosed, though the reimplanted profunda remained patent. He had stable residual endoleaks of the right profunda and bilateral popliteal arteries. He was asymptomatic. Genetic work up showed no pathogenic variants, except for a variant of undetermined significance in the cystathionine beta synthase gene. While optimal management is unclear in such rare pathology, we have found success in short term follow up with a hybrid repair. Patients presenting with this require extensive follow up and multidisciplinary care. View Large Image Figure Viewer Download Hi-res image

Prefabrication-a Vascularized Skin Flap Using an Arteriovenous LoopPrefabricated Flap With Arteriovenous Loop: An Experimental Study in Minipigs.

Arteriovenous loops have a high potency to induce angiogenesis and are promising to solve the problem of scarce implanted pedicle sources and insufficient neovascularization in flap prefabrication. But there is a lack of large animal experiments to support their clinical application. Therefore, we aimed to explore the feasibility of prefabricating large flaps based on arteriovenous loops in pigs. Five minipigs were used. In the experimental group, a 10-cm-long ear vein graft was microanastomosed with the saphenous artery and vein to form an arteriovenous loop and implanted under the medial thigh flap. A month later, a 10×10cm prefabricated flap pedicled with the arteriovenous loop was elevated and sutured in situ. In the control group, a 10×10cm flap with no vascular pedicle was elevated completely and sutured in situ in the same position. The patency of the arteriovenous loop was evaluated by angiography 30 days after implantation, and the viability of flaps was assessed by macroscopic analysis 10 days after elevation. Three animals received arteriovenous loop flaps unilaterally and no-pedicle flaps unilaterally. Two animals received arteriovenous loop flaps bilaterally. In the experimental group, no thrombi were exhibited in any arteriovenous loop. All 7 prefabricated flaps survived uneventfully. In the control group, 3 flaps were completely necrotic. The arteriovenous loops with long interpositional venous grafts can be used as vascular pedicles to prefabricated large area and well-vascularized flaps. This approach can greatly expand the application of flap prefabrication.

Cricoid Augmentation by Costal Cartilage Graft in the Treatment of Complex Crico-Tracheal Stenosis in Adults.

We present herein our results of cricoid augmentation with costal cartilage in complex crico-tracheal stenosis in adults. This is a retrospective analysis of a prospectively maintained data of patients who underwent surgery for crico-tracheal stenosis at a tertiary care centre from March 2012 to September 2019. Finding of subglottic stenosis with cricoid narrowing was taken as an indication for cricoid split and costal cartilage graft augmentation. Their demographic and clinical data, pre-operative work up, intra-operative details and post-operative course was recorded. Ten patients underwent cricoid split with costal cartilage graft augmentation and crico-tracheal anastomosis between March 2012 and November 2019. The mean age was 29years (range, 22-58years). There were 6 males (60%) and 4 females (40%). All 10 patients underwent circumferential resection of stenosed tracheal segment, cricoid split, interposition of costal cartilage graft and an anastomosis between augmented cricoid and trachea. Eight patients (80%) anterior cricoid split and 2 (20%) had anterior as well as posterior split. Average resected length of trachea was 2.39 cms. Cricoid split with costal cartilage augmentation is a feasible option to expand cricoid lumen in crico-tracheal stenosis. None except one of our patients required any further intervention in mean follow up of 42months and all are free from primary symptoms. The functional results of the surgery were also excellent in 90% of the patients.

Effect of Acellular Dermal Matrix on Long-Term Speech Outcomes in Primary Palatoplasty with Radical Intravelar Veloplasty.

This study investigates whether the use of acellular dermal matrix (ADM) affects the long-term speech outcomes in patients undergoing primary palatoplasty with radical intravelar veloplasty. Retrospective cohort study. Tertiary university-affiliated hospital. A consecutive cohort of 112 patients who underwent primary palatoplasty with radical intravelar veloplasty from August 2014 to March 2018 were included. A 2 × 2 cm-sized ADM was incorporated as an interpositional graft between the oral and nasal lining at the soft-hard palate junction. The perceptual analysis of hypernasality and articulation was performed when the age of the patient reached at least 36 months. Cleft-related characteristics and surgical factors affecting the speech outcomes were investigated. The ADM was applied in 57 patients with a mean follow-up of45.76 months (SD, 10.69), while no ADM was used in 55 patients with a mean follow-up of 48.43 months (SD, 14.98). Regarding the hypernasality outcome, 33.3% (19 of 57 patients) of the ADM group and 27.3% (15 of 55 patients) of the control group showed a greater than mild-to-moderate degree. The distribution of hypernasality and articulation grade showed no significant difference between the two groups. After controlling for potential risk factors that may affect the speech outcomes, the use of ADM showed no significant relationship with velopharyngeal insufficiency. The use of ADM use in primary palatoplasty with radical intravelar veloplasty is not associated with the alteration of speech function in early childhood.

Long-Term Results of Autologous Bifurcated Carotid Artery Reconstructions

Carotid bifurcation revascularization using interposition grafts is rare. While internal carotid artery (ICA) revascularization is regarded as mandatory, the external carotid artery (ECA) is severed in most instances. Long-term results of an autologous bifurcated carotid artery reconstruction are discussed. Single centre, retrospective analysis of a consecutive series of patients treated at an academic vascular surgery center. From 12/2006 to 11/2019, fifty-one patients underwent reconstruction of the carotid artery using an autologous bifurcated interposition graft (38 male, 75%; median age: 68.7 years; IQR: 60.2-76.5). Thirty-eight patients were asymptomatic (74.5%). Indication for reconstruction was recurrent carotid stenosis unfavourable for endovascular treatment/redo patchplasty (n=32, symptomatic: n=7), carotid aneurysm (n=11, symptomatic: n=5), neck tumor with vascular involvement (n=7), trauma (n=1). Non-reversed valve depleted saphenous vein y-graft from the groin was used in 49 (94.2%) and reversed cubital vein bifurcation in three (5.8%) procedures. Median ICA cross-clamp time was 15 minutes (IQR: 13-20 minutes). In four procedures (7.7%), a shunt was inserted because of significant decrease of cerebral perfusion. In one patient, additional intraoperative stent placement of a proximal common carotid artery (CCA) stenosis was performed. Six patients suffered from ischemic neurological deficits (11.5%), all but 1 recovered with no or moderate symptoms. After a median follow-up of 5.2 years (IQR: 1.1-8.7 years), 7 significant asymptomatic stenoses (13.5%) and 2 occlusions (3.8%, one symptomatic) of the ICA, two significant asymptomatic CCA stenoses (3.8%), five significant stenoses (9.6%) and seven asymptomatic occlusions (13.5%) of the ECA were observed. This prompted 7 re-redo-interventions in 5 patients. Twenty-eight patients (54.9%) died after a median follow up of 3.3 years (IQR: .5-5.6 years). Two of these patients died due to conditions related to the performed carotid artery reconstruction. Autologous bifurcated carotid artery interposition graft provides results comparable to other complex ICA-revascularizations. Overall survival in this heterogeneous patient cohort is poor. Due to high risk of stroke and poor long-term outcome, this procedure should be reserved for symptomatic patients with no other option for revascularization.