Early and late geometric changes after carotid endarterectomy patch reconstruction.

Abstract

This study examines the degree and location of vessel wall geometric changes after carotid endarterectomy-vein patch reconstruction. The external diameters of the proximal common carotid, common carotid bulb, and internal carotid arteries were measured during operation with a caliper after 349 carotid endarterectomies. There were 309 saphenous vein reconstructions, 31 synthetic patch reconstructions, and 9 primary closures. One or more B-mode ultrasound studies with cross-sectional views for common and internal carotid cursor measurements were performed from 3 months to 5 years after operation. The intraoperative-to-postoperative common carotid diameters were unchanged for the three types of reconstructions. The internal carotid diameters increased 20% to 30% for both the vein and synthetic patched arteries. This dilation was present at 3 and 6 months and progressed slightly over 5 years. Wall thickening greater than or equal to 1 mm was present in 62% of the carotid endarterectomies, with concentric stenosis in 3% and eccentric stenosis in 59%. Eccentric stenosis was present at 3 to 6 months, located on the endarterectomized posterior-medial wall of the common and internal carotid arteries, was always less than 50%, and changed very little over 5 years. No aneurysms or internal carotid occlusions were identified. Carotid endarterectomy-vein patch reconstruction results in early, mild, nonaneurysmal dilation of the internal carotid patched segment, frequent mild eccentric restenosis, and rare hemodynamically significant concentric restenosis.