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Carotid Replacement Grafts for Extracranial Atherosclerotic Disease

Richard A. Razzino, MD

Paul M. Orecchia, MD

David Calcagno, MD

PinnacleHealth Hospitals, Harrisburg, Pennsylvania

Carotid artery reconstruction using interposition grafts is usually indicated for management of recurrent stenosis where endarterectomy cannot be performed, where quality of the carotid artery is unsatisfactory following endarterectomy, or where there are aneurysmal changes in the artery. The purpose of this study was to evaluate the perioperative and long-term results in patients who underwent carotid replacement grafts.

The authors conducted a retrospective chart review of 758 operations performed for extracranial carotid disease between August 1987 and February 1995. In 10 of these cases, the quality of the carotid artery following endarterectomy was so thin or had such an irregular surface that replacement grafts were necessary.

In three of these 10 patients, surgery had been performed for recurrent carotid stenosis. Autogenous vein was utilized in seven cases, and prosthetic material was used in three cases (polytetrafluoroethylene [PTFE] in two cases and Dacron in one case). Follow-up was complete in all patients and ranged from 16 to 87 months (mean, 47 months). Serial duplex scans were performed in all cases. All grafts remained patent, but duplex scanning detected severe stenosis in two of the 10 grafts at 7 and 39 months, respectively, after the initial reconstruction. In both cases, contrast angiography confirmed the findings. In both patients, the areas of stenosis occurred in the midportion of a reversed vein graft at a valve site. The stenoses were corrected without further restenosis. There were no postoperative stenoses in the three cases where prosthetic material was used. There were no early or late strokes or deaths.

The late secondary patency of carotid artery replacement grafts is excellent. Intraoperative detection and ablation of venous valves or choosing a vein segment without valves when autologous grafts are used may decrease the incidence of secondary stenosis. Serial duplex scanning is recommended for both short-term and long-term follow-up.

Vascular and Endovascular Surgery, Vol. 32, No. 5, 479-483 (1998)
DOI: 10.1177/153857449803200513


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