Document Detail


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.
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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


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