Patch Angioplasty In Carotid Endarterectomy Research Articles

Fatigue of textiles used in vascular surgery: Application to carotid endarterectomy

Fatigue is a material-based phenomenon playing a significant role in the mechanical behavior of components and structures. Although fatigue has been well studied for traditional materials, such as metals, its underlying mechanisms are not thoroughly understood in novel applications such as the case of textiles used as patches to close the arteriotomy in carotid endarterectomy. The latter is a type of vascular surgery for the treatment of carotid artery disease in which after an arteriotomy and removal of atherosclerotic plaque closure is made with a patch sutured on the artery. Completion of the operation signals the initiation of complex mechanical and hemodynamic phenomena. Fatigue performance of the patch eventually determines the successful outcome of carotid endarterectomy. In this study, we evaluate with a two-fold approach the mechanics of patch angioplasty in carotid endarterectomy. First, an analytical model for the fatigue behavior of textiles is developed, considering the microstructure and geometry of the fabric. Then, the surgical procedure is simulated and a finite element analysis of the endarterectomized and patched carotid artery is employed. Stress fields are calculated, while deformation at the site of patch angioplasty indicates a potential cause for the formation of aneurismal degeneration after the surgery. Such analysis can provide a better understanding in the establishment of follow-up protocols.

Carotid endarterectomy with primary closure versus patch angioplasty in patients with symptomatic and significant stenosis: protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials

IntroductionUse of patch angioplasty in carotid endarterectomy (CEA) is suggested to reduce the risk of restenosis and recurrent ipsilateral stroke. The objective is to conduct a systematic review with meta-analysis...

P.098 Primary closure versus expansile patch angioplasty for carotid endarterectomy: a single center series

Background: Carotid endarterectomy (CEA) is a common treatment option for patients presenting with carotid stenosis; however, the optimal method for arterial closure remains unclear. Therefore, we examined our single center series to compare primary closure versus patch angioplasty for carotid endarterectomy. Methods: We reviewed all patients who underwent CEA from 2008 to 2016. Closure method was entirely based on the surgeon style (i.e., all patients treated by vascular surgeons underwent patch angioplasty and all individuals managed by neurosurgeons undergone primary closure). Data were reported as frequencies and outcomes as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: A total of 713 patients were included (349 in the primary closure group and 364 in the patch group). Underlying baseline characteristics were similar between both groups. The risk of transient ischemic attack (OR, 7.08; 95%CI, 0.41-2.84; P=0.872), stroke (OR, 1.14; 95%CI, 0.58-2.22; P=0.697), myocardial infarction (OR, 1.10; 95% CI, 0.39-3.07; P=0.851), cranial nerve palsy (OR, 1.79; 95%CI, 0.65-4.91; P=0.248), and post-operative neck hematoma (OR, 1.04; 95%CI, 0.48-2.24; P=0.923) didn’t differ significantly between the two closure options. Conclusions: Our findings suggest that primary closure and expansile angioplasty have similar safety and efficacy profiles as treatment closure options among patients undergoing CEA.

Durability of Carotid Endarterectomy with Bovine Pericardial Patch

Multiple studies have shown that patch angioplasty after carotid endarterectomy (CEA) reduces the risk of stroke and restenosis when compared with primary closure. Biological, synthetic, or vein patches have been traditionally used in CEA. This article reports the early and long-term outcomes of bovine pericardium (BP) for patch angioplasty in CEA. A retrospective, consecutive analysis of 874 patients who underwent CEA during the past 17years at Mayo Clinic, Florida, was performed. BP patch (BPP) was used in 680 patients. Other CEA techniques were used in 194 patients (standard without patch, 78; standard with Dacron, 74; standard with vein patch, 16; and other techniques: bypasses, 26). We defined group 1 as those who underwent BPP angioplasty and group 2 as those who underwent all other techniques. Early and late clinical outcomes and patch-related complications (restenosis, infection, and hematoma) were recorded and analyzed. Median follow-up for the entire series was 39.6months. There were no statistically significant differences in 30-day mortality and morbidity between the 2 groups, except that BP group has less 30-day stroke (0.1%, 1 of 680) versus other techniques (1.5%, 3 of 194, P=0.03). Thirty-day postoperative mortality rate was 0.1% (1 of 680) in BPP group and 1.0% (2 of 194) in other technique group (P=0.13). No statistically significant difference was noted in 30-day postoperative major complications (transient ischemic attack [TIA], wound infection, hematoma requiring surgical evacuation, and nerve injury) between the 2 groups. Ten-year freedom from stroke/TIA were 97.8% in the BP group compared with 98.5% in the other group (P=0.86). Ten-year freedom from restenosis was also similar between groups (89.0% BP vs. 90.4% others, P=0.69). Ten-year survival rate was 38.4% in BP group and 45.0% in other technique group, and this was statistically significant on univariate analysis only. CEA with BP angioplasty has excellent early and late outcomes with minor morbidity and mortality.

Use of the Vascu-Guard Bovine Pericardium Patch for Arteriotomy Closure in Carotid Endarterectomy. Early and Long-Term Results

To report the early and long-term results of Vascu-Guard bovine pericardium (BP) for patch angioplasty in carotid endarterectomy (CEA). We retrospectively analyzed the data of 256 CEAs with BP patch closure performed in 238 patients during the past 12 years in our department. Patch-related complications (restenosis, infection, and aneurysm formation) and early and late (12 to 144months follow-up) clinical outcomes were recorded and statistically analyzed. Thirty-day postoperative stroke rate was 1.2% (3/256) with zero mortality. Major complications occurred in 3.5% (9 of 256) of the procedures and cranial nerve injury in 4.3% (11 of 256). At 12 years, cumulative estimates of freedom from any stroke, stroke-free survival, and freedom from restenosis were 88.4% (standard error [SE]: 3.3%), 60% (SE: 7.8%), and 98.3% (SE: 0.8%), respectively. No patient experienced patch infection or aneurysm formation. This series shows the efficacy, safety, and durability of CEA with BP patch closure, in both the short and long term. BP combines the advantages of vein and synthetic patches, representing a suitable option when performing CEA.

Comparison of Outcomes between Primary Closure vs. Patch Angioplasty in Carotid Endarterectomy

Purpose: The aim of this study was to compare the short and long-term outcomes following carotid endarterectomy (CEA) with either primary closure (PC) or patch angioplasty (PAT) performed by single center vascular surgeons. Methods: Between November 1994 and March 2008, a total of 366 patients underwent 401 consecutive primary CEA procedures at our institution. We retrospectively reviewed patients’ medical records. Two vascular surgeons prefer routine PC and one vascular surgeon prefer routine patch closure using bovine pericardial patch. Postoperative neurologic complications were determined by clinical neurologists. Restenosis was defined as ＞50% stenosis on follow-up duplex scan. Data was analyzed to compare the early (≤30 days) and late results of CEA between PC group and PAT group. Results: The mean follow-up duration was significantly longer in the PC group than that in the PAT group (61.7 months vs. 41.2 months, P＜0.001). Coronary artery disease and combined CEA with coronary artery bypass were more common in the PAT group (39% vs. 55%, P＜0.002; 4% vs. 12%, P＜0.004). Perioperative ipsilateral TIA/stroke rates in the PC and PAT groups were 1.5% and 0.7% (PC=4/270 vs. PAT=1/131, P=0.564). Regarding late outcomes, Kaplan-Meier analysis failed to show any difference between 2 groups on freedom from ipsilateral transient ischemic attack (TIA)/stroke, freedom from restenosis and TIA/stroke-free survival (P=0.851, P=0.232, P=0.103, log-rank test). Conclusion: Our results suggest that PC following CEA is not necessarily inferior to PAT for experienced surgeons.

How Useful Is Patch Angioplasty in Carotid Endarterectomy?

How Useful Is Patch Angioplasty in Carotid Endarterectomy?

Synthetic patch angioplasty proves useful in carotid endarterectomy

Patch angioplasty is performed to prevent recurrent stenosis after carotid endarterectomy (CEA). Controversy surrounds the selection of the patch material, with supporters for both autogenous tissue and synthetic patches. We reported on the efficacy of synthetic patch angioplasty. Thirty-four carotid endarterectomies with synthetic patch angioplasty, Hemashield Finesse® and Gore-Tex®, were performed on 32 patients. Twenty-eight of the thirty-four cases were classified as elective CEA and six were emergency CEA. The clinical outcome, perioperative complications, and incidence of recurrent stenosis (> or =50%), as detected by MRA and ultrasonography, were examined. Postoperatively, one severe acute stroke patient who underwent emergency CEA died from gastrointestinal bleeding. The perioperative permanent neurologic morbidity was 0% in elective CEA, and five of the six emergency CEA patients recovered. The total permanent morbidity and mortality rate in all CEA with synthetic patch angioplasty was 2.9%. No recurrent stenosis or further stroke occurred in the postoperative long-term follow-up period. Synthetic patch angioplasty in CEA is considered useful to prevent recurrent stenosis, and to avoid vein harvest site complications and patch rupture as previously described with vein patch angioplasty. Finally, there have been no thrombotic complications using synthetic patch angioplasty in emergency CEA.

Double-layer everted saphenous vein patch angioplasty for carotid endarterectomy.

Saphenous vein patch angioplasty is the preferred method of closure of the arteriotomy site during carotid endarterectomies. A major early complication of the saphenous vein patch is rupture of the patch which can occur within the first few postoperative days. The reported incidence varies from 0.5% to 4%. Patch rupture can result in stroke or death. From May 1992 to April 1999, autogenous everted double-layer saphenous vein patch was used in 192 carotid endarterectomies performed on 168 patients; 96 males and 72 females. The age range was from 54 to 94 years with a mean age of 73 years. The saphenous vein is harvested from the ankle. It is everted and then used as a double-layer patch. The follow-up period was from 3 to 74 months, with a mean of 24 months. Postoperatively, there were no patch ruptures or late aneurysm formation. There was no perioperative mortality. Everted double-layer saphenous vein patch eliminates the risk of patch rupture and at the same time retains the benefits of an autologous nonprosthetic graft. Saphenous vein from the ankle can be safely used for carotid angioplasty as a double layer patch.

Processed Bovine Pericardium as Patch Angioplasty for Carotid Endarterectomy: A Preliminary Report

Although the routine use of a patch for closure of the arteriotomy after carotid endarterectomy is still debated, patch angioplasty is frequently used to avoid residual stenosis and to lower the incidence of later restenosis. Several materials are widely used for carotid patching, notably, autologous vein, Dacron and polytetrafluorethylene (PTFE). During recent years a heterologous stabilized graft made from bovine pericardium has been introduced. This paper reports the authors' experience of 52 carotid endarterectomies in which a patch of bovine pericardium was used to close the arteriotomy. The patients were followed with colour-duplex scanning over 12–30 months. This biograft did not require preclotting and proved to be easy to suture. Follow-up did not uncover any complications related to graft use. Although this is a preliminary report, it is concluded that bovine pericardium is a promising material for carotid patch angioplasty.

Processed bovine pericardium as patch angioplasty for carotid endarterectomy: a preliminary report

Although the routine use of a patch for closure of the arteriotomy after carotid endarterectomy is still debated, patch angioplasty is frequently used to avoid residual stenosis and to lower the incidence of later restenosis. Several materials are widely used for carotid patching, notably, autologous vein, Dacron and polytetrafluorethylene (PTFE). During recent years a heterologous stabilized graft made from bovine pericardium has been introduced. This paper reports the authors' experience of 52 carotid endarterectomies in which a patch of bovine pericardium was used to close the arteriotomy. The patients were followed with colour-duplex scanning over 12–30 months. This biograft did not require preclotting and proved to be easy to suture. Follow-up did not uncover any complications related to graft use. Although this is a preliminary report, it is concluded that bovine pericardium is a promising material for carotid patch angioplasty. Copyright © 1996 The International Society for Cardiovascular Surgery.

Expanded polytetrafluoroethylene patch angioplasty in carotid endarterectomy.

This study retrospectively reviewed the experience with expanded polytetrafluoroethylene (ePTFE) patches for carotid endarterectomy in 924 consecutive procedures (753 patients) during a 17-year period. The records of all patients who underwent ePTFE patch angioplasty for carotid artery stenosis performed by one surgeon were reviewed. The criterion for surgery was stenosis of 80% or greater. Follow-up by use of noninvasive methods was done by 6 months after operation the first year and annually thereafter. Recurrent stenosis was confirmed with angiography. Life-table analysis was used to estimate the risk of restenosis. Early morbidity and mortality included six deaths (0.6%), seven nonfatal strokes (0.9%), and 19 hemorrhages. Two postoperative infections occurred. There were no important aneurysmal dilations and no late hemorrhages. With a mean follow-up of 41.4 months (range 0 to 197), recurrent stenosis necessitating reoperation developed in 28 patients (3.7%). There were two late strokes. Life-table analysis indicated a 89% probability of freedom from stenosis at 120 months. In cases in which the decision to perform patch angioplasty is made at surgery, an ePTFE patch is an excellent alternative to autogenous saphenous vein, with a low rate of recurrences requiring operation and acceptable rates of perioperative and postoperative morbidity and mortality.

Everted cervical vein patch angioplasty for carotid endarterectomy: Herbert Dardik, MD, Fred Wolodiger, MD, Silvia Berry, RVT, Ray Vazquez, MD, Fred Silvestri, MD, Ibrahim M. Ibrahim, MD, Mark Kahn, MD, and Barry Sussman, MD, Englewood Hospital, Englewood, N.J.

Everted cervical vein patch angioplasty for carotid endarterectomy: Herbert Dardik, MD, Fred Wolodiger, MD, Silvia Berry, RVT, Ray Vazquez, MD, Fred Silvestri, MD, Ibrahim M. Ibrahim, MD, Mark Kahn, MD, and Barry Sussman, MD, Englewood Hospital, Englewood, N.J.

Patch angioplasty in carotid endarterectomy. Advantages, concerns, and controversies.

There is much controversy in the literature regarding the precise role of patch angioplasty in carotid endarterectomy. Our report summarizes the theoretical and experimental considerations, including the hemodynamic effects and biologic behavior of the graft, associated with this technique. We present a detailed review of the literature regarding the clinical efficacy of patch angioplasty in carotid endarterectomy, including the early results, the late results, and the incidence and nature of carotid restenosis. We address concerns about the use of patch angioplasty, including the duration of cross-clamping, potential problems with the graft and suture-line disruption, and graft atherogenesis. We conclude that most recent literature indicates that patch angioplasty decreases acute complications (notably carotid occlusion) after carotid endarterectomy and prevents or delays carotid restenosis. As pressure increases to achieve a minimal rate of perioperative morbidity, many surgeons are expected to adopt patch angioplasty in more of their cases. However, in the absence of conclusive results from a prospective randomized study, opinion will continue to be divided regarding the routine versus the selective use of patch grafting in carotid endarterectomy. We present criteria for randomized trials of this technique.