Long term outcomes of carotid endarterectomy using bovine pericardium patch compared with other techniques
Warner A. Oldenburg, M.D, Tariq Almerey, M.D, Mahmoud selim, M.D, Houssam Farres, M.D, Albert Hakaim, M.D.
Mayo Clinic, Jacksonville, FL, USA.
Background:
Multiple studies have shown that patch angioplasty following carotid endarterectomy (CEA) reduces the risk of stroke and restenosis when compared with primary closure. Biological, synthetic, or vein patches have been traditionally used in CEA. We report the early and long term outcomes of bovine pericardium (BP) for patch angioplasty in CEA compared with other techniques (standard without patch, Dacron, and vein patch)
Methods:
Retrospective analysis of 874 patients who underwent CEA during the past 17 years in our department was performed. Bovine pericardium patch was used in 680 patients. Other CEA techniques were used in 194 patients (standard without patch) (78), (standard with Dacron) (74), and (standard with vein patch) (16). Early and late clinical outcomes and patch related complications (re-stenosis, infection and hematoma) were recorded and analyzed.
Results:
Median follow-up for the entire series was 34.8 months. There were no statistically significant differences in 30-day mortality and morbidity between the two groups, except that BP group has less 30-day stroke (0.1%, 1 of 680) vs standard without patch ( 3.8%, 3 of 75, p=0.004). Thirty-day post-operative mortality rate was 0.1% (1 of 680) in BP group and 0.5% (1 of 194) in other techniques group. Thirty-day post-operative stroke rate was 0.1% (1 of 680) in BP group and 1.5% (3 of 194) in other techniques group. No statistically significant difference was noted in thirty-day postoperative major complications (TIA, wound infection, hematoma requiring surgical evacuation and nerve injury) between the two groups. Ten years freedom from stroke/TIA were (98.86%) in the BP group compared with (99.43%) in the other group without statistical significant difference (p=0.761). Freedom from restenosis was also similar between groups (89.0% BP vs 89.3% others, p=0.821). Ten-year survival rate was 38.60% in BP group and 45.08% in other techniques group (p=0.039), the difference between BP and Dacron group remained statistically significant after adjusting for impact of age and diabetes.
Conclusion:
Carotid endarterectomy with BP angioplasty has excellent early and late outcomes with minor morbidity and mortality. We found lower 30-day stroke rate in BP group compared to standard without patch group but also lower long-term survival rate in BP group compared to Dacron group.
Back to 2017 Program
