Patch closure improves results with carotid endarterectomy.

The type of closure after a carotid endarterectomy, primary closure versus patch angioplasty, is controversial. Most authorities agree that in a small carotid artery (</=4 mm), particularly in the presence of technical difficulties at the internal carotid artery end of the arteriotomy, closing with a patch may avoid restenosis. Our randomized prospective studies confirm the conclusions of several others that patching in general is superior to primary closure in lowering the incidence of perioperative stroke, acute postoperative internal carotid artery thrombosis, or both. Both vein patch closure and polytetrafluoroethylene patching are superior to primary closure in this regard. Patching (polytetrafluoroethylene or saphenous vein patching) is also significantly superior in reducing significant recurrent carotid artery stenosis over the long-term. We also conclude that for those who like to preserve the saphenous vein, the preferential use of polytetrafluoroethylene or Dacron Hemashield Finesse patching may be appropriate.