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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References
- The first carotid endarterectomy.J Vasc Surg. 2014 Dec; 60 (8 e1-4. PubMed PMID: 25238726. Epub 20140916): 1703
- Successful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up.JAMA. 1975 Sep 8; 233 (PubMed PMID: 1174155): 1083-1085
- Surgical treatment of arteriosclerotic occlusion of common carotid artery.J Neurosurg. 1956 Sep; 13 (PubMed PMID: 13367885): 500-506
- Benefits of carotid patching: a randomized study.J Vasc Surg. 1988 Feb; 7 (PubMed PMID: 3276933): 240-247
- A systematic review of the randomised trials of carotid patch angioplasty in carotid endarterectomy.Eur J Vasc Endovasc Surg. 1997 Apr; 13 (PubMed PMID: 9133984): 345-354
- Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy.J Vasc Surg. 2004 Dec; 40 (PubMed PMID: 15622366): 1126-1135
- Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy.Asian J Surg. 2011 Jan; 34 (PubMed PMID: 21515211): 32-40
- Patch angioplasty or primary closure following carotid endarterectomy for symptomatic carotid artery stenosis.Surg J. 2018 Apr; 4 (PubMed PMID: 29915809. Pubmed Central PMCID: PMC6003887. Epub 20180615): e96-e101
- Complication rate after carotid endarterectomy comparing patch angioplasty and primary closure.Ann Vasc Surg. 2016 Jan; 30 (PubMed PMID: 26541968. Epub 20151102): 248-252
- Carotid endarterectomy with patch angioplasty versus primary closure in patients with symptomatic and significant stenosis: a systematic review with meta-analyses and trial sequential analysis of randomized clinical trials.Syst Rev. 2021 May 6; 10 (PubMed PMID: 33957978. Pubmed Central PMCID: PMC8103619. Epub 20210506): 139
- Comparative analysis of patch angioplasty versus selective primary closure during carotid endarterectomy performed at a single vascular center in China.Ann Vasc Surg. 2021 May; 73 (PubMed PMID: 33383139. Epub 20201228): 344-350
- Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease.J Vasc Surg. 2011 Sep; 54 (PubMed PMID: 21889701): e1-e31
- Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease.J Vasc Surg. 2022 Jan; 75 (PubMed PMID: 34153348. Epub 20210619): 4S-22S
- Primary closure after carotid endarterectomy is not inferior to other closure techniques.J Vasc Surg. 2016 Sep; 64 (PubMed PMID: 27189766. Epub 20160514): 678-683 e1
Article info
Publication history
Published online: October 06, 2022
Accepted:
October 5,
2022
Received in revised form:
September 17,
2022
Received:
March 24,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
