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Carotid Endarterectomy Using Everted Cervical Vein Patching: Immediate and Long Term Results

OBJECTIVES: To compare results of carotid endarterectomy (CEA) using everted cervical vein (ECV) with other methods of closure in a consecutive series of CEAs performed over a 22 year period.
METHODS:
We retrospectively analyzed clinical data on all consecutive CEAs performed by a single surgeon between 1982 to 2004. CEAs were performed using closure by ECV, prosthetic patch (PP), primary closure (PC), or eversion endarterectomy (EE). Operations for recurrent stenosis and those performed during aortocoronary bypass were excluded. Demographic data, risk factors, and rates of postoperative morbidity and mortality for ECV were compared with other methods of closure. Patients received follow-up with duplex ultrasonography to identify restenosis. Data was analyzed using Fisher’s exact test and survival analysis.
RESULTS:
609 consecutive CEAs were reviewed consisting of closure by ECV (129), PP (321), PC (121), and EE (38). ECV patients were comparable in pre-operative characteristics and had a lower peri-operative stroke rate than other groups combined [1/129 (0.78%) vs. 20/480 (4.2%), P=0.097]. ECV patients had a significantly lower peri-operative stroke rate than the PP group [1/129 (0.78%) vs. 15/321(4.7%), P=0.048]. There was no difference in peri-operative mortality rate. The median follow-up time was 96 months and ECV patients experienced significantly longer stroke-free survival than other groups combined (P=0.023). ECV patients also experienced significantly longer stroke-free survival than the PP group (P=0.021) The rate of restenosis >70% was lower for the ECV group, but, this was not statistically significant [ECV 3.0%, All others 4.8%, PP 4.0%, PC&EE 5.9%].
CONCLUSIONS:
ECV provides autogenous closure for CEA without the need for saphenectomy. Cervical vein is a readily available source of autogenous patch material and eliminates the morbidity of saphenous vein harvesting. The procedure is associated with a lower peri-operative stroke rate, greater stroke-free survival, and similar rates of late restenosis compared with other methods of closure.