Comparison of results of carotid artery surgery after either direct closure or use of a vein patch.

In order to assess the benefit of vein patching versus direct closure after carotid endarterectomy, a series of 2271 carotid operations were analysed retrospectively. Apart from 114 procedures consisting of saphenous vein bypass (n = 29) and eversion endarterectomy (n = 85), 2157 open endarterectomies were performed. They were closed either directly (n = 837) or using a vein patch (n = 1320). The combined mortality-major neurological morbidity rate was 1.7%, i.e. 1% mortality (0.2% neurological) and 0.7% permanent neurological morbidity (0.5% ipsilateral to the operated artery). Early symptomatic internal carotid thrombosis was documented in six cases (four following direct closure and two after vein patching). A total of 827 carotid arteries were followed up by duplex scanning on an annual basis (244 direct closure and 583 vein patching). The mean follow-up was 44 months; 69 months for direct closure and 35 months for vein patching. In direct closure, there were 21 stenoses (9%) and 10 occult thromboses (4%); in vein patching carotids, there were 17 stenoses (3%), nine thromboses (1.8%) [corrected] and six pseudoaneurysms (1%). Annual incidence of poor results was 2.4% in direct closure, and 0.87% in vein patching. The only other factor responsible for a significant difference was gender (3.4% in women versus 2.1% in men). In this retrospective study, vein patching appears to be beneficial for the prevention of acute postoperative thrombosis and late stenosis or thrombosis.