Does Patch Type Make a Difference During Carotid Endarterectomy in the VQI?
Milap R. Patel, BS1, Martin Durkin, MD, MPH, MAS2, Firas F. Mussa, MD, MS, FACS1.
1University of South Carolina School of Medicine, Columbia, SC, USA, 2Palmetto Health, Columbia, SC, USA.
Background: Patch angioplasty have been shown to improve rates of restenosis after carotid endarterectomy (CEA). This study was conducted to compare distinct outcome variables among the three different types of patches within the Vascular Quality Initiative (VQI).
Methods: The VQI was retrospectively queried between September 2012 and September 2017. Demographics, presences of neurological symptoms and operative details were compared based on patch types. The outcome variables compared were: 30-day and 1-year return to the operating room (ROR) and stroke. VQI results are presented as percentages with a precision to the nearest tenth of a percent. We computed relative risks for all possible scenarios given the imprecision of the data.
Results: 34,928 CEA procedures were performed during the study period. Mean age was 70.3 ± 9.2; 60.2% were men and 43.4% had prior neurological events, 43.4%). Patch distribution as was follows: bovine pericardium (n = 23,704), dacron (n = 10,311), and autogenous vein (n = 913). Follow up was limited to 1 year. There was no evidence of differential risk by patch type for 30-days and 1-year ROR. Dacron patch was protective against stroke at 1 year (risk ratio ranged from 0.76-0.83; 100% of p<0.05). There was no increased risk of ROR based on patch type.
Conclusion: Within the VQI, bovine pericardium has replaced dacron as the most commonly used type of patch during CEA. Dacron patch showed less risk of stroke at 1 year after CEA when compared to bovine pericardial patch. No difference in rates of ROR among groups. This should be further investigated.
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