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Carotid Endarterectomy Using the Eversion Technique has Equivalent Restenosis Rates as Patch Angioplasty and Costs Less to Perform: An Eight - Year Single Institution Experience
Emilia Krol, MD, Aleksandra Ogrodnik, MD, Richard Hsu, MD, Dahlia Plummer, MD, Alan Dietzek, MD.
Danbury Hospital, Danbury, CT, USA.
Introduction:
Recurrent stenosis after carotid endarterectomy is a known complication, and occurs in approximately 7% of cases. Recent reports in the published literature have suggested, that the restenosis rates following eversion endarterectomy are higher than when carotid surgery is performed with the use of a patch. The purpose of our study was to retrospectively compare the rates of carotid re-stenosis and operative materials costs in patients, who underwent carotid endarterectomy with bovine patch angioplasty vs the eversion endarterectomy performed in a single institution.
Methods:
Retrospective chart review was performed on all patients who underwent carotid endarterectomy in our institution between January 2004 and July 2012. Patients’ demographics as well as operative method were investigated. Post - operative results of carotid duplex scans were performed at 6, 12, 24, 36, 48, 60, 72 and 84 months. We obtained the cost for synthetic and bovine patches from the hospital purchasing department.
Results:
In 8 - year period 502 patients (199 women, mean age: 73.6 years) underwent carotid endarterectomies, 212 of which were eversions. The remainder were performed with bovine patch angioplasty in all cases. The cost for the bovine patch was 120$. All surgeries were performed by board certified vascular surgeons. One patient in this group developed post - operative patch infection and required reoperation with saphenous vein bypass. Critical stenosis was detected by duplex ultrasound using NASCET criteria in 5 patients (2.3%) in the eversion group and in 7 patients in the patch angioplasty group (2.4%) within 3 years. All symptomatic recurrences were treated with operative or endovascular reintervention and occurred in 2/5 and 3/7 patients in the eversion and patch angioplasty groups respectively.
Conclusion:
In contrast to recent reports in the literature, experience in our institution shows that the carotid re-stenosis rates were not statistically higher for eversion endarterectomy than for patch angioplasty. In addition there is no additional cost for a patch which would have resulted in a cost savings of more than $35,000 dollars in our institution. Furthermore, the risk of patch infection, a potentially devastating complication, is eliminated with the use of the eversion technique.
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