Synthetic Patch Research Articles

Carotid Artery Pseudoaneurysm after Carotid Endarterectomy and Bovine Pericardial Patch Angioplasty: Case Report

Synthetic patch infection and pseudoaneurysm are rare but recognised complications of carotid endarterectomy (CEA). We describe a case of bovine patch infection with Serratia marcescens with acute pseudoaneurysm formation following CEA. Successful interposition vein graft was performed.

Intraoperative sealing of dura mater defects with a novel, synthetic, self adhesive patch: application experience in 25 patients

Background. The quest for an ideal sealant for dura mater defects persists. The clinical experience with a novel, synthetic self-adhesive patch (TissuePatchDural®, Tissuemed, Leeds, UK) and its ability to prevent postoperative cerebrospinal fluid (CSF) leakage is described in this article. Methods. A recently developed, synthetic, self adhesive patch was implanted in 25 patients who underwent intradural neurosurgical procedures. The indication for use was to adjunctively seal dura mater defects. The device is a multi-laminate consisting of thin films of a commonly used structural polymer, poly(lactide-co-glycolide) and a tissue reactive polymer providing fast and strong chemical bonding of the patch with the underlying biological surface. Intraoperative handling and efficacy, biocompatibility, and postoperative observations/follow-up were analysed. Infectious complications, surgical wound features, and postoperative MRI scans were especially reviewed. The mean follow up period was 4.4 months. Results. The device provided fast and efficacious sealing of circumscribed dura mater defects within 1 minute in 23 patients (92%). Two of 25 patients developed a postoperative CSF leakage (8%), which may be secondary to particular factors predisposing these patients to CSF leaks. Surgical handling was straightforward. No infectious complications were recorded; furthermore, wound healing was unremarkable. No clinical evidence of foreign body reactions was observed. In 18 patients, postoperative MRI scans were available which did not show irregularities in any case. Conclusions. Safe and effective sealing can be accomplished with this bioabsorbable, purely synthetic and thin dural sealant, avoiding the application of foreign biologic material. The product has been shown to be effective in achieving watertight closure of the dura mater and has prevented CSF leakage in 92% of patients treated.

Quantification of Extensional Uncertainty of Segmented Image Objects by Random Sets

Investigations in data quality and uncertainty modeling are becoming key topics in geoinformation science. This paper models a collection of outcomes from a standard segmentation algorithm as a random set. It quantifies extensional uncertainties of extracted objects using statistical characteristics of random sets. The approach is applied to a synthetic data set and vegetation patches in the Poyang Lake area in China. These patches are of interest as they have both sharp and vague boundaries. Results show that random sets provide useful spatial information on uncertainties using their basic parameters like the mean, level sets, and variance. The number of iterations to achieve a stable covering function and the sum of the variances are good indicators of boundary sharpness. The coefficient of variation has a positive relation with the degree of uncertainty. An asymmetry ratio reflects the uneven gradual changes along different directions where broad boundaries exist. This paper shows that several characteristics of extensional uncertainty of segmented objects can be quantified numerically and spatially by random sets.

Massive rotator cuff tear treated with a synthetic patch: a case report 16 years after surgery

Massive rotator cuff tears usually cannot be repaired due to tendon atrophy and marked retraction, as well as muscles fatty degeneration. There are several options for surgical treatment: open or arthroscopic debridement with or without subacromial decompression, arthroscopic isolated biceps tenotomy, partial tendon repair, use of synthetic or biologic patches, tendon transfers, hemiarthroplasty, reverse arthroplasty, and arthrodesis. In this article, we will discuss a particular case of massive rotator cuff tear treated with Marlex mesh. The patient was clinically, radiologically, and MRI checked 16 years after the surgical implant. The active function of shoulder had preserved very well, the Constant score was 76. The X-rays showed a limited progression of osteoarthritis without further cranial migration of the humeral head. At MR cartilage preservation was appreciated, the patch being in good position and the teres minor being smaller than average but it was nonetheless present. This case report can highlight the usefulness of patches in patients with irreparable rotator cuff lesion both for the immediate benefit in terms of pain, strength, movement, and in perspective allowing for the preservation of anatomical structures that might avoid the need for a prosthetic implant over the years.

Optimizing PANi doped electroactive substrates as patches for the regeneration of cardiac muscle

In scaffold aided regeneration of muscular tissue, composite materials are currently utilized as a temporary substrate to stimulate tissue formation by controlled electrochemical signals as well as continuous mechanical stimulation until the regeneration processes are completed. Among them, composites from the blending of conductive (CPs) and biocompatible polymers are powerfully emerging as a successful strategy for the regeneration of myocardium due to their unique conductive and biological recognition properties able to assure a more efficient electroactive stimulation of cells. Here, different composite substrates made of synthesized polyaniline (sPANi) and polycaprolactone (PCL) were investigated as platforms for cardiac tissue regeneration. Preliminary, a comparative analysis of substrates conductivity performed on casted films endowed with synthesized polyaniline (sPANi) short fibres or blended with emeraldine base polyaniline (EBPANi) allows to study the attitude of charge transport, depending on the conducting filler amount, shape and spatial distribution. In particular, conducibility tests indicated that sPANi short fibres provide a more efficient transfer of electric signal due to the spatial organization of electroactive needle-like phases up to form a percolative network. On the basis of this characterization, sPANi/PCL electrospun membranes have been also optimized to mimic either the morphological and functional features of the cardiac muscle ECM. The presence of sPANi does not relevantly affect the fibre architecture as confirmed by SEM/image analysis investigation which shows a broader distribution of fibres with only a slight reduction of the average fibre diameter from 7.1 to 6.4 μm. Meanwhile, biological assays--evaluation of cell survival rate by MTT assay and immunostaining of sarcomeric α-actinin of cardiomyocites-like cells--clearly indicate that conductive signals offered by PANi needles, promote the cardiogenic differentiation of hMSC into cardiomyocite-like cells. These preliminary results concur to promise the development of electroactive biodegradable substrates able to efficiently stimulate the basic cell mechanisms, paving the way towards a new generation of synthetic patches for the support of the regeneration of damaged myocardium.

Vermiform Appendix Inside A Hernia: Our Experience

Aim: The presence of the vermiform appendix inside a hernia sac is usually called Amyand's or De Garengot Hernia. The purpose of this study is to report our experience with 12 cases within the last 15 years.Methods: We searched patient files of our department since 1992 and found 12 cases of patients with the appendix found inside a hernia. Patient characteristics, treatment and postoperative outcome were analyzed.Results: There were ten men and two women with a median age of 74 years (range 55-90). Seven patients (six males, one female) presented to the emergency department with a tender inguinal mass and were operated under the diagnosis “strangulated hernia”, with an inflamed appendix inside the hernia found intraoperatively in six of them while in one male patient a strangulated sliding hernia containing the cecum with the appendix was found. Appendectomy was performed in all patients but the one with the strangulated sliding hernia. Hernias were repaired with the use of synthetic patch or suture technique depending on individual patient characteristics. The other four male patients were routinely operated for right inguinal hernia and the appendix was found intraoperatively. Appendectomy was performed in all patients and the hernia was repaired with the use of a polypropylene mesh. The other female patient was operated for an incisional hernia (right lower quadrant) and appendectomy was performed with suture repair of the hernia.Conclusion: The inflammatory status of the appendix combined with the patient's individual characteristics determines the hernia repair. Appendicectomy should be performed as long as it does not complicate the recovery of the patient.

Herniación transdural espontánea de la médula espinal con recidiva temprana

Idiopathic transdural spinal cord herniation (ITSCH) is a little-known medical condition that causes large duration progressive myelopathy that can be diagnosed based on the radiological manifestations on magnetic resonance imaging (MRI) prior to surgery. We present the case of a 61-year-old woman with spastic myelopathy (Brown-Sequard syndrome) and conclusive diagnosis of ITSCH by MRI. Surgery was carried out with reduction of the spinal cord and repair of the dural defect with clinical improvement but paraplegia at the metameric D5 level (ASIA D). However, six months after surgery a new progressive neurologic worsening was present with recurrent spinal cord herniation diagnosis confirmed with MRI. A second surgery was carried out, covering the dural defect with synthetic patch. Although persistence of neurologic deficits after spinal surgery is common, recurrence of spinal cord herniation is extremely rare. It must be considered as a possible differential diagnosis in case of progressive neurologic deterioration after an initial favorable course.

PS80. Systematic Review of Randomized Controlled Trials of Patch Angioplasty Versus Primary Closure and Different Types of Patch Materials During Carotid Endarterectomy

Patch angioplasty during carotid endarterectomy (CEA) may reduce the risk for perioperative or late carotid artery recurrent stenosis and subsequent ischemic stroke. We performed a systematic review of randomized controlled trials to assess the effect of routine or selective carotid patch angioplasty compared with CEA with primary closure, and the effect of different materials used for carotid patch angioplasty. Randomized trials during 1966-2009 were included if they compared carotid patch angioplasty with primary closure in any patients undergoing CEA or use of one type of carotid patch with another. Twenty-three eligible randomized trials were identified. Ten trials involving 2157 operations compared primary closure with routine patch closure, and thirteen trials with 2083 operations compared different patch materials. Patch angioplasty was associated with a reduction in risk for ipsilateral stroke during the perioperative period (p = 0.001), and long-term follow-up (p = 0.001). Patching was also associated with reduced risk for perioperative arterial occlusion (P <.0001) and decreased recurrent stenosis during long-term follow-up (p < 0.001). Seven trials that compared between vein and synthetic patches showed that apart from psudoanaeurysmal formation, there were no significant different in the outcome between vein patch and synthetic materials in either the short- or long-term. There were significantly fewer pseudoaneurysms associated with synthetic patches than vein patches (p = 0.005) Carotid patch angioplasty decreases the risk for both ipsilateral stroke in both perioperative and long-term risk. More data are required to establish differences between various patch materials.

Attenuation of Left Ventricular Adverse Remodeling With Epicardial Patching After Myocardial Infarction

Background Previous studies suggested that epicardial patch applied to the infarcted site after acute myocardial infarction (MI) can alleviate left ventricular (LV) remodeling and improve cardiac performance; however, the effects of regional epicardial patch on chronic phase of LV remodeling remain unclear. Methods and Results We studied 20 pigs with MI induced by distal embolization and impaired LV ejection fraction (LVEF <45%) as detected by gadolinium-enhanced cardiac magnetic resonance imaging (MRI). Eight weeks post-MI, all animal underwent open chest procedure for sham surgery (control, n = 12) or patch implantation over the infarcted lateral LV wall (patch group, n = 12). In the patch group, +dP/dt increased and LV end-diastolic pressure decreased at 20 weeks compared with immediately post-MI and at 8 weeks ( P < .05), but not in the control group ( P > .05). As determined by cardiac MRI, LV end-diastolic and end-systolic volumes increased at 20 weeks compared with 8 weeks in both groups ( P < .05). However, the increase in LV end-diastolic volume (+14.1 ± 1.8% vs. +6.6 ± 2.1%, P = .015) and LV end-systolic volume (+12.1 ± 2.4% vs. −4.7 ± 3.7%, P = .0015) were significantly greater in the control group compared with the patch group. Furthermore, the percentage increase in LVEF (+17.3 ± 4.9% vs. +4.1 ± 3.9%, P = .048) from 8 to 20 weeks was significantly greater in the patch group compared with the control group. Histological examination showed that LV wall thickness at the infarct region and adjacent peri-infarct regions were significantly greater in the patch group compared with the control group ( P < .05). Conclusion Regional application of a simple, passive synthetic epicardial patch increased LV wall thickness at the infarct region, attenuated LV dilation, and improved LVEF and +dP/dt in a large animal model of MI.

Patches of different types for carotid patch angioplasty

Carotid patches for carotid endarterectomy may be made from an autologous vein or synthetic material. To assess the safety and efficacy of different materials for carotid patch angioplasty. We searched the Cochrane Stroke Group trials register (last searched 3 August 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2009), MEDLINE (1966 to November 2008), EMBASE (1980 to November 2008) and Index to Scientific and Technical Proceedings (1980 to 2008). We handsearched relevant journals and conference proceedings, checked reference lists, and contacted experts in the field. Randomised and quasi-randomised trials comparing one type of carotid patch with another for carotid endarterectomy. Two review authors independently assessed eligibility, trial quality, and extracted data. We included 13 trials involving a total of 2083 operations; seven trials compared vein closure with PTFE closure, and six compared Dacron grafts with other synthetic materials. In most trials a patient could be randomised twice and have each carotid artery randomised to different treatment groups. There were no significant differences in the outcomes between vein patches and synthetic materials apart from pseudoaneurysms where there were fewer associated with synthetic patches than vein patches (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02 to 0.49). However, the numbers involved were small and the clinical significance of this finding is uncertain. Compared to other synthetic patches, Dacron was associated with a higher risk of: perioperative combined stroke and transient ischaemic attack (P = 0.03); restenosis at 30 days (P = 0.004); perioperative stroke (P = 0.07) and perioperative carotid thrombosis (P = 0.1). During follow-up for more than one year, there were also significantly more strokes (P = 0.03), stroke/death (P = 0.02) and arterial restenoses (P < 0.0001) with Dacron but the numbers of outcomes were small and the significance of this finding is uncertain. The number of outcome events is too small to allow reliable conclusions to be drawn and more trial data are required to establish whether any differences do exist. Nevertheless, there is some evidence that other synthetic (e.g. PTFE) patches may be superior to collagen impregnated Dacron grafts in terms of perioperative stroke rates and restenosis. Pseudoaneurysm formation may be more common after use of a vein patch compared with a synthetic patch.

Extracranial Internal Carotid Artery Mycotic Aneurysm: A Case Report

Mycotic aneurysms of the extracranial carotid arteries (MCAs) are extremely rare. They usually appear as an enlarging pulsatile neck mass with no specific signs and symptoms, and they can lead to severe morbidity and mortality if left untreated. We report a case of a saccular thrombosed MCA in a 68-year-old man, presented as a non-pulsatile enlarging mass. The patient did not have any clinical signs of infection, and he was treated with resection of the MCA and synthetic patch reconstruction of the carotid bifurcation. Postoperative microbial cultures revealed Streptococcus parasanguinis. We review and discuss the literature regarding the clinical presentation, diagnosis and treatment options of MCAs.

Cardiac herniation following completion pneumonectomy for bronchiectasis

Sporadic reports on cardiac herniation are available in the literature; most of them had followed intrapericardial pneumonectomies for malignant pulmonary tumors. We present an uncommon event of heart herniation after a completion pneumonectomy indicated for chronic bronchiectasis. A 35-year-old male patient was operated for left completion pneumonectomy. A 6 cm x 4 cm area of adherent pericardium near the obtuse margin of heart was removed during surgery. During head-end elevation of the bed in postoperative intensive care unit, patient got accidentally tilted to the left side, which resulted in ventricular fibrillation. Chest cavity was re-opened for cardiopulmonary resuscitation. Left ventricle was found herniating through the pericardial deficiency into the left-thoracic cavity with the cardiac apex touching chest wall. During surgical re-exploration, the pericardial deficiency was closed with a synthetic Dacron patch. Hemodynamic condition remained stable in the immediate postoperative period. Patients had infection of the left thoracic cavity after 5 weeks, for which he was subjected to thoracoplasty and omentopexy. Prompt recognition with timely intervention is life saving from cardiac herniation. Strategy of closing the pericardial defect after pneumonectomy should be followed routinely, irrespective of the indication for pneumonectomy.

Patch angioplasty versus primary closure for carotid endarterectomy

Carotid patch angioplasty (with either a venous or a synthetic patch) may reduce the risk of carotid artery restenosis and subsequent ischaemic stroke. This is an update of a Cochrane Review originally published in 1995 and previously updated in 2004. To assess the safety and efficacy of routine or selective carotid patch angioplasty compared to carotid endarterectomy with primary closure. We searched the Cochrane Stroke Group Trials Register (last searched 5 May 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2009), MEDLINE (1966 to November 2008), EMBASE (1980 to November 2008) and Index to Scientific and Technical Proceedings (1980 to November 2008). We handsearched journals and conference proceedings, checked reference lists, and contacted experts in the field. Randomised and quasi-randomised trials comparing carotid patch angioplasty with primary closure in any patients undergoing carotid endarterectomy. Two review authors independently assessed eligibility, trial quality and extracted data. We included 10 trials involving 1967 patients undergoing 2157 operations. The quality of trials was generally poor. Follow up varied from hospital discharge to five years. Carotid patch angioplasty was associated with a reduction in the risk of ipsilateral stroke during the perioperative period (odds ratio (OR) 0.31, 95% confidence interval (CI) 0.15 to 0.63, P = 0.001) and long-term follow up (OR 0.32, 95%CI 0.16 to 0.63, P = 0.001). It was also associated with a reduced risk of perioperative arterial occlusion (OR 0.18, 95% CI 0.08 to 0.41, P < 0.0001), and decreased restenosis during long-term follow up in eight trials (OR 0.24, 95% CI 0.17 to 0.34, P < 0.00001). These results are more certain than those of the previous review since the number of operations and events have increased. However, the sample sizes are still relatively small, data were not available from all trials, and there was significant loss to follow up. Very few arterial complications, including haemorrhage, infection, cranial nerve palsies and pseudo-aneurysm formation were recorded with either patch or primary closure. No significant correlation was found between use of patch angioplasty and the risk of either perioperative or long-term all-cause death rates. Limited evidence suggests that carotid patch angioplasty may reduce the risk of perioperative arterial occlusion and restenosis. It would appear to reduce the risk of ipsilateral stroke and there is a non significant trend towards a reduction in perioperative any stroke rate and all-cause case fatality.

Carotid Artery Pseudoaneurysm After Carotid Endarterectomy: Case Series and a Review of the Literature

Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare complication with incidence less than 1%. There is a potential for rupture, embolization, thrombosis or compression of cranial nerves. We reviewed our experience and compare it to the literature to raise awareness of this rare though serious condition. It is crucial to treat these patients early to avoid the hazardous consequences. A review of the case records of patients who had CEA at University Hospital Birmingham (UHB) NHS Foundation Trust from 1990-2007, was undertaken. Information of patients including their aetiology, presenting features, treatment and results was collected. The English-language literature was searched using PubMed database for post CEA pseudoaneurysm. Five patients developed post CEA PA. This represents 0.4% of the 1200 CEA performed at our hospital in the last 18 years. The timing of their presentation varied from three days to eight months after the original operation. All had patch reconstruction after CEA. Patches were intact at exploration of the PAs. There was one death and one stroke. The literature revealed 154 carotid PAs after CEA and two cases following carotid stenting 52 of these cases had infected PA. Patients with synthetic patches have the least incidence of infection. More than 80% had open surgery and 9% had endovascular repair. Post CEA surveillance is necessary to detect patients with PA early. Factors that favour infection must be avoided. Endovascular repair of carotid PA should be encouraged in specialised centres.

How we do it: endoscopic trans-nasal repair of CSF rhinorrhoea

Endoscopic repair of CSF rhinorrhoea was first described in the early 1980s. Since then the endoscopic approach has overtaken the intracranial route as the procedure of choice due to superior visualisation of the operative field, reduced operating time & lower complication rates. Various autogenous, allogenic and synthetic patching materials have been used to augment repair. We describe a step wise technique of patching the skull base defect using a combination of septal mucoperichondrial flap and tensor fascia lata graft. from 1st Scientific Meeting of the Head and Neck Optical Diagnostics Society London, UK. 14 March 2009

Dacron Patch Infection Following Carotid Endarterectomy: A Systematic Review of the Literature

Our report encompasses two cases of Dacron patch infection following carotid endarterectomy and a systematic review of the literature. Particular attention is placed on the incidence, aetiology, investigation, presentation and management dilemmas of this rare complication of carotid surgery. We present all known cases of synthetic patch infection following carotid endarterectomy over the last 12 years. 14 publications have been identified totalling 77 cases of graft infection. Approximately 0.25–0.5% of all Dacron patches appear to get infected. Infection may present early or late and appears to have a bi-modal distribution depending on the presence of low- or high-grade infection. Post-operative complications especially wound haematoma is associated with the later development of infection. Most patients present with pseudoaneurysm formation, neck swelling or a draining local sinus and are infected with either Staphylococcus epidermidis or Staphylococcus aureus. Duplex ultrasound is the investigation of choice and complete excision of all infected material and arterial reconstruction with a vein patch or graft is recommended. Dacron patch infection is a rare but recognised complication of carotid surgery and knowledge of this condition is vital for vascular surgeons and other speciality surgeons to whom cases may present.

Thoracoscopic Repair of Neonatal Diaphragmatic Hernia

The use of minimally invasive surgery (MIS) in the neonatal population is increasing. Thoracoscopic intervention for congenital diaphragmatic hernia (CDH) is no exception. In this report, we describe our initial experience with thoracoscopic repair of left-sided diaphragmatic defects in neonates. We performed retrospective chart reviews on all neonates who underwent thoracoscopic repair of CDH between November 2004 and January 2008. Neonates that underwent thoracoscopic repair were physiologically stable with resolved pulmonary hypertension and minimal to moderate ventilatory support. They had no associated cardiac anomalies. We identified 15 neonates with CDH who underwent thoracoscopic repair during the study period. Ten neonates underwent primary repair of the diaphragmatic defect. Five neonates with large defects required closure with a synthetic patch, which was placed thoracoscopically. The average operating room time was 134 minutes. There were no instances of intraoperative respiratory or cardiac instability. Three patients had a recurrence. One recurrence was seen after thoracoscopic patch repair. Two recurrences occurred following primary repair of left diaphragmatic hernias. There were no deaths. Follow-up has been 4-40 months. Neonatal MIS for CDH should be limited to stable patients. The ideal candidate is the newborn without associated anomalies, not requiring extracorporeal membrane oxygenation, on minimal ventilatory support, and without evidence of pulmonary hypertension. It is technically possible to perform thoracoscopic repair with a patch.

Surgical outcome of degenerative versus postreconstructive extracranial carotid artery aneurysms

Extracranial carotid artery aneurysms (ECAAs) are rare vascular lesions, and large series with short-term and long-term outcomes are seldom reported. This study compared the clinical presentation and conventional treatment outcomes of different ECAA types according to their etiology. We retrospectively reviewed the data of 55 consecutive patients (47 men, 8 women) with 61 ECAAs who were treated from January 1986 to December 2007 by conventional surgical techniques. The patients were a mean age of 65 +/- 11 years (range, 30-92 years). Thirty-two ECAAs (52.5%) occurred postoperatively after previous carotid endarterectomy, of which 26 patients had 29 degenerative aneurysms (47.5%). Clinical presentation included cerebral stroke in three patients (4.9%) and transient ischemic attack in 26 (42.7%). Mean follow-up was 42.7 +/- 22.0 months. Statistical analysis was performed within and between degenerative and post-reconstructive ECAA subgroups of patients. Open aneurysm resection included 27 extended polytetrafluoroethylene interposition grafts, 12 venous grafts, and 22 closures using synthetic patch. Cumulative 1-year primary patency rates were 86.9% for the degenerative ECAAs and 96% for the postoperative ECAAs, with respective secondary patency rate at 5 years of 80% and 93.3%. The 5-year patency rate was 88.9% for synthetic grafts compared with 66.7% for vein grafts and 86.4% for synthetic patches. These differences were not statistically significant (P > .05). Complications for the degenerative ECAAs included two reconstruction thromboses <30 days, two cerebral strokes, and one myocardial infarction. The patients with postoperative ECAAs experienced one early thrombosis and two strokes postoperatively. Two patients (3.6%) from the degenerative ECAA subgroup died of cardiac decompensation (n = 1) and cerebral ischemic event (n = 1). Despite the different trends, no significant differences were found between degenerative ECAA and postoperative ECAA patients in clinical presentation, localization, and surgery outcomes. The good middle-term and long-term patency rates of synthetic graft reconstruction justify its use in the treatment of ECAAs, and it is less time consuming and technically demanding compared with vein interposition graft.

Invited Commentary

Invited Commentary

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

Saphenofemoral junction (SFJ) ligation has been a major component of surgical intervention for varicose veins; however, recurrence occurs in as many as 40%. Neovascularization with reconnection of the venous channels at the transected SFJ has been identified as the major cause of this recurrence. This randomized controlled study sought to evaluate mechanical suppression of neovascularization at the SFJ, with the use of a synthetic patch, to prevent recurrence after ligation surgery. A total of 389 limbs (from 292 patients) were randomized into either control (SFJ ligation surgery) or patch (SFJ ligation with polytetrafluoroethylene patch of the transected SFJ) groups. All patients underwent clinical assessment, duplex imaging, and air plethysmography studies preoperatively and at 1, 6, 12, and 36 months postoperatively. The patch consistently halved the recurrence rate to 3 years postoperatively in all clinical subgroups. In those patched SFJs that still developed recurrence, evidence of neovascularization circumventing the polytetrafluoroethylene patch was observed by both ultrasound and histology. This study demonstrates that use of a polytetrafluoroethylene patch is an effective mechanical suppressant of neovasculogenesis at the SFJ and can be safely used as a strategy to improve long-term outcome of varicose vein surgery.