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Titolo:
Redo carotid surgery: An analysis of materials and configurations used in carotid reoperations and their influence on perioperative stroke and subsequent recurrent stenosis
Autore:
Rockman, CB; Riles, TS; Landis, R; Lamparello, PJ; Giangola, G; Adelman, MA; Jacobowitz, GR;
Indirizzi:
NYU Med Ctr, Dept Surg, Div Vasc Surg, New York, NY 10016 USA NYU Med CtrNew York NY USA 10016 , Div Vasc Surg, New York, NY 10016 USA
Titolo Testata:
JOURNAL OF VASCULAR SURGERY
fascicolo: 1, volume: 29, anno: 1999,
pagine: 72 - 80
SICI:
0741-5214(199901)29:1<72:RCSAAO>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
TERM FOLLOW-UP; ARTERY STENOSIS; PRIMARY CLOSURE; SAPHENOUS-VEIN; SURGICAL-MANAGEMENT; PATCH ANGIOPLASTY; SUBCLAVIAN BYPASS; NATURAL-HISTORY; ENDARTERECTOMY; DISEASE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
47
Recensione:
Indirizzi per estratti:
Indirizzo: Rockman, CB 530 1st Ave,Ste 6F, New York, NY 10016 USA 530 1st Ave,Ste 6FNew York NY USA 10016 w York, NY 10016 USA
Citazione:
C.B. Rockman et al., "Redo carotid surgery: An analysis of materials and configurations used in carotid reoperations and their influence on perioperative stroke and subsequent recurrent stenosis", J VASC SURG, 29(1), 1999, pp. 72-80

Abstract

Objective: The ideal method of arterial reconstruction in operations for recurrent carotid disease after prior endarterectomy is unknown. The goal ofthis study was to review a series of carotid reoperations and to determinewhether the surgical technique influenced the rate of perioperative stroke, late stroke, or secondary restenosis. Methods: A retrospective review was conducted of 82 carotid reoperations performed on 74 patients at our institution. Results: The patient population included 39 men (52.7%) and 35 women (47.3%), with a mean age of 67.5 years. The indications for redo surgery included transient ischemic attack or amaurosis fugax in 35.3% of the patients, stroke in 6.1%, and asymptomatic restenosis (>80%) in 58.5%. Patch angioplasty with or without redo endarterectomy was used in 47 cases (57.3%), with saphenous vein in 26 (31.7%), Dacron in 15 (18.3%), and polytetrafluoroethylene in 6 (7.3%). Interposition grafting was used in 35 cases (42.7%), with saphenous vein in 9 (11.0%), Dacron in 10 (12.2%), and polytetrafluoroethylene in 16 (19.5%). The perioperative complications included three strokes (3.7%). There was a trend toward increased perioperative neurologic complications with interposition grafting when compared with patch angioplasty (8.6%vs 2.1%), although this did not reach statistical significance. Long-term clinical follow-up was obtained in ail cases with a mean duration of 35 months, with follow-up duplex scanning performed in 89.2%. The late failures of redo surgery included four significant secondary restenoses and five total occlusions. There was a trend towards improved long-term results with interposition grafting as opposed to patch angioplasty. However, the cases in which reconstruction was performed vith a vein had a significantly higher rate of late failures (stroke, secondary recurrent stenosis, or occlusion) than those in which reconstruction was performed with any prosthetic material (26.7% vs 2.3%; P=.002 by Fisher exact test). Conclusion: The use of autologous material for redo carotid surgery in anyconfiguration appears to significantly increase the rate of subsequent recurrent stenosis or total occlusion of the operated artery The reason for this finding is unclear but may be related to both host and technical factors. Prosthetic material may be more durable in the long-term for redo carotidsurgery. Interposition grafting for redo carotid surgery may increase the perioperative neurologic complication rate to some degree; however, this was not statistically significant in this series. Interposition grafting may be a more durable solution in longterm follow-up than redo endarterectomy and patch angioplasty. A longer follow-up period will be needed to confirm this conclusion.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/10/20 alle ore 12:08:52