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OBJECTIVES: Routine patching and periodic postoperative duplex have been widely advocated to achieve optimal results after carotid endarterectomy (CEA). The present 21 year single surgeon experience evaluates the long term outcome of CEA with selective patching and without routine postoperative duplex evaluation.

METHODS: An IRB approved retrospective review of all CEAs performed by a single surgeon over a 21 year (1984-2005) period. Preoperative imaging studies, operative reports, physical findings, and co-morbid conditions as well as pre- and postoperative medications were evaluated. Patients having undergone follow-up duplexes are the basis for this review. Restenosis was defined as angiographic criteria suggesting an 80% or more diameter reduction requiring re-intervention.

RESULTS: Over a 21 year period, 384 CEAs were performed using a selective patch technique depending on gender, internal carotid artery diameter, cardiovascular risk factors, and preoperative arteriogram. Eighty (20.8%) patients had duplexes performed at this institution as part of their regular follow-up. The remaining 304 patients had clinical follow-up on a yearly basis. Ten of eighty (12.5%) had prosthetic or vein patch closure and seventy of eighty (87.5%) underwent primary closure. The mean follow-up was 49.5 months with a range of 1 to 237 months. Restenosis in the patch group was zero of ten (0%). Sixty-six of seventy (94.2%) patients of the primary closure group did not show any evidence of restenosis. Four patients (5.8%) had arteriographically proven greater then 90% stenosis and required repeat CEA. The remaining 304 patients without routine postoperative duplex remained neurologically asymptomatic (mean follow-up 10.3 years, range 2.5 to 17 years).

CONCLUSIONS: In this experience, there is no statistically significant difference in restenosis in the primary closure and selective patch group following CEA. Additionally, the absence of routine postoperative duplex failed to change the clinical outcome in a majority of patients. Although this data set is a small, single center, single surgeon, retrospective review, it does not support the generally well accepted view of routine patching following CEA.