Carotid endarterectomy with homologous vein patch angioplasty: A review of 1006 cases

Purpose: Because homologous vein is rarely used in vascular reconstructions, we evaluated the homologous vein as a patch for the reconstruction of the carotid bifurcation after endarterectomy. Methods: Excess vein harvested during open heart operations was either refrigerated in saline solution or cryopreserved in a solution of 10% dimethyl sulfoxide. Donors were tested for transmissible infections, and the veins were cultured for common pathogens. Data were analyzed from 837 consecutive patients (1006 cases) who underwent carotid endarterectomy with homologous vein patch angioplasty between 1981 and 1993. Results: The perioperative mortality rate was 0.8% (eight patients). Two deaths (0.2%) were attributed to ipsilateral strokes. Ischemic strokes occurred in 12 patients (1.2%; 10 ipsilateral), and ipsilateral transient ischemic attacks occurred in three patients (0.3%). Follow-up data were obtained for 482 patients (56%; mean follow-up time, 61 months; range, 1 to 132 months). Ipsilateral recurrent symptoms occurred in eight patients (1.7%; seven strokes, one transient ischemic attack). Of the 63 late deaths (13%), the majority (25 patients; 40%) were caused by complications of coronary artery disease. The 10-year overall survival rate was 76% ± 3.2%, and the 10-year rate of freedom from late ipsilateral morbidity was 96% ± 1.4%. The 10-year rate of freedom from late stenosis (a reduction in diameter of ≤20%) in the 220 arteries (22%) that were studied by duplex scan was 84% ± 2.3%> Conclusions: The postoperative mortality and neurologic morbidity rates of carotid endarterectomy with homologous vein patch angioplasty are similar to those in the best series with all types of closure. The existing long-term follow-up data indicate that the homologous vein is a durable patch that behaves like other patches used in the same location.