Annals of Vascular Surgery

, Volume 7, Issue 5, pp 407–413 | Cite as

Does carotid eversion endarterectomy and reimplantation reduce the risk of restenosis?

  • René Kieny
  • Didier Hirsch
  • Christian Seiller
  • Jean-Claude Thiranos
  • Hélène Petit
Original Articles
  • 6 Downloads

Abstract

Two hundred twelve eversion endarterectomies of the internal carotid artery and reimplantation in the common carotid artery were performed between January 1985 and July 1990. A total of 206 patients with stenosis of 75% or more and with redundancy and tortuosity of the internal carotid artery underwent this procedure. Cumulative mortality and neurologic morbidity were 2.4%. Forty patients died during the course of follow-up, seven of neurologic causes (17.1%). Duplex scans of 107 operated carotid arteries were obtained an average of 27.1 months after surgery. Restenosis of >50% was encountered in three patients (1.9%), two asymptomatic patients (1.3%) with >75% restenosis and one symptomatic patient with occlusion (0.6%). These results contrast with a 13.5% rate of restenosis >50% (including 5.9% of restenoses >75% and 1.7% occlusions) observed after 156 consecutive endarterectomies performed and closed by direct suture by the same surgical team in 1987 at a mean follow-up of 44 months. We believe that this technique can be used more often because the operative and long-term risks are not any greater than those of the other methods of carotid revascularization. Eversion endarterectomy associated with reimplantation is especially indicated when the internal carotid artery is elongated, is <4 mm wide, and occurs in women.

Keywords

Public Health Carotid Artery Internal Carotid Artery Internal Carotid Symptomatic Patient 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    O'Donnell TF, Callow AD, Scott G, et al. Ultrasound characteristics of recurrent carotid disease: Hypothesis explaining the low incidence of symptomatic recurrence. J Vasc Surg 1985;2:26–41.PubMedGoogle Scholar
  2. 2.
    Nicholls SC, Phillips DJ, Bergelin RO, et al. Carotid endarterectomy: Relationship of outcome to early restenosis. J Vasc Surg 1985;2:375–381.PubMedGoogle Scholar
  3. 3.
    Zbornikova V, Elfstrom J, Lassvik C, et al. Restenosis and occlusion after carotid surgery assessed by duplex scanning and digital subtraction angiography. Stroke 1986;17:1137–1142.PubMedGoogle Scholar
  4. 4.
    De Groote RD, Lynch TG, Jamil Z, et al. Carotid restenosis: Long-term noninvasive follow-up after carotid endarterectomy. Stroke 1987;18:1031–1036.PubMedGoogle Scholar
  5. 5.
    Sanders EACM, Hoeneveld H, Eikelboom BC, et al. Residual lesions and early recurrent stenosis after carotid endarterectomy: A serial follow-up study with duplex scanning and intravenous digital subtraction angiography. J Vasc Surg 1987;5:731–737.PubMedGoogle Scholar
  6. 6.
    Habozit B. Suivi anatomique de l'endartériectomie carotidienne. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 67–75.Google Scholar
  7. 7.
    Kieny R, Mantz F, Kurtz Th, et al. Less resténoses carotidiennes après endartériectomie. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 77–100.Google Scholar
  8. 8.
    Healy DA, Zierler RE, Nicholls SC, et al. Long-term follow up and clinical outcome of carotid restenosis. J Vasc Surg 1989;10:662–669.PubMedGoogle Scholar
  9. 9.
    Atnip RG, Wengrowitz M, Gifford RR, et al. A rational approach to recurrent carotid stenosis. J Vasc Surg 1990;11:511–516.PubMedGoogle Scholar
  10. 10.
    Bernstein EF, Torem S, Dilley RB. Does carotid restenosis predict an increased risk of late symptoms, stroke or death? Ann Surg 1990;212:629–636.PubMedGoogle Scholar
  11. 11.
    Ouriel K, Green RM. Clinical and technical factors influencing recurrent carotid stenosis and occlusion after endarterectomy. J Vasc Surg 1987;5:702–706.PubMedGoogle Scholar
  12. 12.
    Katz NM, Jones GT, Degenhardt J, et al. The use of patch angioplasty to alter the incidence of carotid restenosis following thromboendarterectomy. J Cardiovasc Surg 1987;28:2–8.Google Scholar
  13. 13.
    Hertzer NP, Beven EG, O'Hara PJ, et al. A prospective study of vein patch angioplasty during carotid endarterectomy: Three-year results for 801 malades and 917 operations. Ann Surg 1987;206:628–635.PubMedGoogle Scholar
  14. 14.
    Eikelboom BC, Ackerstaff RGA, Ludwig JW, et al. Intérêt du patch en chirurgie carotidienne. In Kieffer E, Natali J, eds. Aspects Techniques de la Chirurgie Carotidienne. Paris: AERCV, 1987, pp 177–181.Google Scholar
  15. 15.
    Rosenthal D, Archie JP Jr, Garcia-Rinaldi R, et al. Carotid patch angioplasty: Immediate and long-term results. J Vasc Surg 1990;12:326–333.PubMedGoogle Scholar
  16. 16.
    Cormier JM, Chapelier A. Résultats tardifs de la revascularisation par greffe veineuse des sténoses athéroscléreuses de la carotide interne. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 101–115.Google Scholar
  17. 17.
    Etheredge SN. A simple technique of carotid endarterectomy. Am J Surg 1970;120:275–278.PubMedGoogle Scholar
  18. 18.
    Thevenet A. Chirurgie des lésions non athéromateuses carotidiennes. In Kieffer E, Natali J, eds. Aspects Techniques de la Chirurgie Carotidienne. Paris: AERCV, 1987, pp 219–239.Google Scholar
  19. 19.
    Jones CE. Carotid eversion endarterectomy revisited. Am J Surg 1989;157:323–328.PubMedGoogle Scholar
  20. 20.
    Civil ID, O'Hara PJ, Hertzer NM, et al. Late patency of the carotid artery after endarterectomy: Problems of definition, follow-up methodology, and data analysis. J Vasc Surg 1988;8:79–85.PubMedGoogle Scholar
  21. 21.
    L'Aurc et Becquemin JP, Souadka F, et al. Risque opératoire actuel de la chirurgie carotidienne: Expérience du groupe vasculaire de l'AURC. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 41–50.Google Scholar
  22. 22.
    Kieffer E, Koskas F, Bahnini A, et al. Résultats cliniques tardifs de la chirurgie carotidienne. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 51–66.Google Scholar
  23. 23.
    Reilly LM, Okuhn SP, Rapp JH, et al. Recurrent carotid stenosis: A consequence of local or systemic factors? The influence of unrepaired technical defects. J Vasc Surg 1990;11:448–460.PubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1993

Authors and Affiliations

  • René Kieny
    • 1
  • Didier Hirsch
    • 1
  • Christian Seiller
    • 1
  • Jean-Claude Thiranos
    • 1
  • Hélène Petit
    • 1
  1. 1.From the Service de Chirurgie CardiovasculaireHôpital CentralStrasbourgFrance

Personalised recommendations