Since early embolic events and recurrent stenosis are, after intraoperative ischemia, the main problems of carotid endarterectomy (CEA), technical im provements that may reduce the incidence of these feared complications are required. The causes of recurrent carotid stenosis may be related to progression of the atherosclerotic disease, to myointimal hyperplasia at the site of endar terectomy, or to technical mistakes during intervention. The choice of patching material seems to be important in preventing late complications.
The authors present their original experience with a biosynthetic ovine patch in carotid surgery. In the period from January, 1988, to June, 1989, 211 carotid endarterectomies were performed for atherosclerotic disease at the carotid bi furcation in 176 patients. A primary closure of the carotid arteriotomy was performed in 82 cases and a patch angioplasty was employed in 129. As the material employed in the patch angioplasty, the authors used the biosynthetic ovine patch in 30 cases.
No deaths and no permanent neurologic deficits were registered in this series during the awakening and during the postoperative care. One patient died one month after the surgical procedure because of myocardial infarction without neurologic symptoms. These patients were admitted to the prospective study for the evaluation of the carotid that was operated on. The study was performed with clinical and instrumental examinations (duplex scanner). Each patient was seen at months 1, 3, 6, and 12 after surgery. All the patients except 3 had a twelve-month follow-up; by echo tomography a case of nonhemodynamic restenosis was detected in an asymptomatic patient six months after CEA.
The authors' preliminary experience with this biosynthetic graft as patching material has been satisfactory. They conclude that this biosynthetic graft, be cause of its handling and particularly its healing characteristics, can be consid ered as a graft material for patching at the carotid level.
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