Patch angioplasty during carotid endarterectomy using different materials has similar clinical outcomes

• Published in: Journal of vascular surgery Vol. 77; no. 2; pp. 559 - 566.e1
• Main Authors: Liesker, David J., Gareb, Barzi, Looman, Rick S., Donners, Simone J.A., de Borst, Gert J., Zeebregts, Clark J., Saleem, Ben R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2023
• Subjects: Aged; Angioplasty - adverse effects; Animals; Bovine pericardial patch; Carotid endarterectomy; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Cattle; Endarterectomy, Carotid - adverse effects; Female; Humans; Ischemic Attack, Transient - etiology; Male; Middle Aged; Patch angioplasty; Polyester; Polyesters; Recurrence; Retrospective Studies; Stroke - etiology; Treatment Outcome; Polyester; Bovine pericardial patch; Carotid endarterectomy; Patch angioplasty
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2022.09.027

Patch angioplasty during carotid endarterectomy (CEA) is commonly used to treat carotid artery stenosis. However, the choice of which patch to use remains a matter of debate. Autologous venous material has disadvantages such as wound-related problems at the harvest site and a prolonged intervention time. These limitations can be bypassed when synthetic or biological patches are used. Both materials have been associated with divergent advantages and disadvantages. Therefore, the aim of our study was to compare the long-term follow-up outcomes in patients who underwent CEA and closure with either a bovine pericardial patch (BPP) or polyester patch. A retrospective cohort study was conducted including all patients who underwent primary CEA and closure with a BPP or a polyester patch between January 2010 and December 2020 at our tertiary referral center. In 2015, the BPP was introduced as an alternative for polyester. The primary outcome was the occurrence of transient ischemic attack (TIA) or cerebrovascular accident (CVA) during follow-up and secondary outcomes included restenosis, reintervention, all-cause mortality, and patch infection. Cox proportional hazard models were used and hazard ratios with 95% confidence intervals were used to predict these outcomes. We included 417 CEA patients; 254 patients (61%) received a BPP and 163 received (39%) a polyester patch. The mean age was 70.2 ± 8.7 years and 67% were male. The median follow-up time was 15 months (range, 12-27 months) for BPP and 42 months (range, 16-60 months) for polyester (P < .001). Postoperative hematoma (≤30 days) was significantly lower in the BPP cohort (2% BPP vs 6% polyester; P = .047). No other significant differences on short-term outcomes were found. Univariable Cox regression analyses showed no significant differences between the effect estimates of polyester and BPP on TIA or CVA (P = .106), restenosis (P = .211), reintervention (P = .549), or all-cause mortality (P = .158). No significant differences were found after adjusting for confounders in the multivariable analyses: TIA or CVA (P = .939), restenosis (P = .057), reintervention (P = .193) and all-cause mortality (P = .742). Three patients with a polyester patch had patch infection compared with none of the patients in the group who received a BPP. This large retrospective study showed comparable safety and durability of both BPP and polyester suggesting that both patch types can be safely applied for CEA with patch angioplasty. Patch infection was rare and was absent in the BPP group.