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Primary arterial closure after carotid endarterectomy is a safe and expeditious technique in appropriately selected patients

Published:October 06, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.009

      Highlights

      • Primary arteriotomy closure is safe with similar peri-operative results.
      • Primary arteriotomy closure does not confer higher restenosis rate.
      • Primary arteriotomy closure is associated with shorter operative time.

      Abstract

      Background

      Carotid endarterectomy (CEA) remains a safe and durable operation for both symptomatic and asymptomatic carotid stenosis, however conflicting evidence exists on the benefit of patch angioplasty and its effects on post-operative outcomes.

      Methods

      A retrospective review of all patients undergoing CEA from 2011 to 2018 was performed.

      Results

      Of 851 patients, primary closure was performed in 277 (33%). Patients with primary closure were older (74 vs 72, p = 0.001), symptomatic (39% vs 34%, p = 0.024), and male (69% vs 31% p < 0.001), with a higher incidence of diabetes mellitus (47% vs 39%, p = 0.046) and ESRD (4% vs 2%, p = 0.015). Restenosis rates were similar (7% vs 8%, p = 0.67). Operative time was shorter for primary closure (87 ± 28 vs 102 ± 26 min, p < 0.001). There were no differences in 30-day ipsilateral stroke rates (1% vs 1%, p = 0.51) or stroke-free survival.

      Conclusions

      Primary arterial closure is safe and expeditious in appropriately selected high-risk patients.
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