A prospective study of vein patch angioplasty during carotid endarterectomy. Three-year results for 801 patients and 917 operations.

From 1983 through 1985, 801 consecutive patients (mean age: 66 years) underwent 917 primary carotid endarterectomies at the Cleveland Clinic. Conventional arteriotomy closure was performed during 483 operations, while patch angioplasty using a distal segment of saphenous vein was employed in 434. Preoperative risk factors, surgical management, and antiplatelet therapy were equivalent in the vein patch (VP) and nonpatch (NP) groups. Early results were evaluated by intravenous angiography (DSA) in 715 patients (89%), and 332 reconstructions (36%) have been reassessed by objective imaging during a mean follow-up interval of 21 months. Ischemic strokes occurred after 18 (1.9%) of the 917 procedures (0.7% VP, 3.1% NP; p = 0.0084), and symptomatic (N = 9) or unsuspected (N = 8) thrombosis of the internal carotid artery was confirmed by neck exploration or routine DSA after 1.9% of all operations (0.5% VP, 3.1% NP; p = 0.0027). Only ten patients (1.2%) have required reoperations for severe recurrent lesions, but the cumulative 3-year incidence of new defects (greater than or equal to 30% stenosis) documented by objective studies in the VP and NP groups was 9% and 31%, respectively (p = 0.0066). These results strongly suggest that VP angioplasty enhances the safety and durability of carotid endarterectomy.