| Intermediate-term outcome of carotid endarterectomy with bovine pericardial patch closure compared with Dacron patch and primary closure. | |
| | |
MedLine Citation:
|
PMID: 22226180 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: Multiple studies have established that patch angioplasty following carotid endarterectomy (CEA) reduces the risk of subsequent stroke and restenosis compared with primary closure. Previous reports have also demonstrated bovine pericardium to be associated with similar rates of postoperative complications and restenosis compared with other patch materials. Due to favorable handling and sonographic properties, bovine pericardium has become increasingly popular as a patch option in recent years. However, the intermediate- and long-term performance of this material remains incompletely defined. Through a retrospective analysis of our carotid endarterectomy experience, we sought to compare the bleeding, infection, and pseudoaneurysm rates with bovine pericardium patch closure to those with Dacron patch and primary closure. In this study, 1331 primary carotid endarterectomies performed in our institution between 1996 and 2008 were grouped according to the method of arteriotomy closure: primary closure (PC) (216, 16.3%), Dacron patch angioplasty (DPA) (642, 48.2%), and bovine pericardial patch angioplasty (BPA) (457, 34.3%). Demographic variable and postoperative outcome measures collected real-time via a designated database manager were assessed by univariate and multivariate analysis. RESULTS: Mean follow-up for the entire cohort was 46.1 months. There were no statistically significant differences in rates of postoperative wound infection, hematoma, pseudoaneurysm formation, or 30-day stroke or 30-day mortality among the three groups. Combined 30-day stroke and death was significantly lower in the PC cohort (0.5% vs 2.3% DPA vs 2.4% BPA; P = .94, BPA vs DPA; P = .001, BPA vs PC; P = .001, DPA vs PC), while 5-year restenosis after both DPA (2.0% ± 0.6%) and BPA (1.1% ± 0.6%) was significantly lower compared with PC (5.2% ± 1.6%) (P = .03, DPA vs PC; P = .008, BPA vs PC; P = .14, BPA vs DPA). Five-year survival following BPA (77.9% ± 3.6%) was significantly improved compared with PC (66.9% ± 3.5%) and DPA (60.8% ± 2.1%) in univariate analysis (P = .24, DPA vs PC; P = .01, BPA vs PC; P = .03, BPA vs DPA), with statin use (P = .004) and male gender (P = .05) being positive predictors of enhanced survival on multivariate analysis. CONCLUSIONS: This single-institution, retrospective review represents the largest reported experience with BPA after CEA to date and is the only report comparing outcomes after BPA to PC or to DPA. Our experience further demonstrates that patch angioplasty is protective against restenosis after CEA compared with PC. Equivalent rates of perioperative bleeding, infection, and pseudoaneurysm formation were seen with each closure strategy in this study. |
| | |
Authors:
|
Karen J Ho; Louis L Nguyen; Matthew T Menard |
Publication Detail:
|
Type: Comparative Study; Journal Article Date: 2012-01-04 |
Journal Detail:
|
Title: Journal of vascular surgery Volume: 55 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2012 Mar |
Date Detail:
|
Created Date: 2012-02-28 Completed Date: 2012-05-01 Revised Date: 2012-10-03 |
Medline Journal Info:
|
Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 708-14 Citation Subset: IM |
Copyright Information:
|
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
|
Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Aneurysm, False / etiology Angioplasty / adverse effects, instrumentation*, mortality Animals Boston Carotid Stenosis / complications, mortality, surgery, therapy* Cattle Chi-Square Distribution Endarterectomy, Carotid* / adverse effects, mortality Equipment Design Female Hematoma / etiology Humans Male Middle Aged Multivariate Analysis Pericardium / transplantation* Polyethylene Terephthalates* Postoperative Hemorrhage / etiology Proportional Hazards Models Recurrence Registries Retrospective Studies Risk Assessment Risk Factors Stroke / etiology Surgical Wound Infection / etiology Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
0/Polyethylene Terephthalates |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Expression of cytoskeleton and energetic metabolism-related proteins at human abdominal aortic aneur...
Next Document: Loss of lymphatic vessels and regional lipid accumulation is associated with great saphenous vein in...