INTRAOPERATIVE ANGIOGRAPHIC ASSESSMENT OF RECONSTRUCTED ARTERY AND USEFULNESS OF SAPHENOUS VEIN GRAFT BRIDGING IN EARLY THROMBOSIS OCCLUSION AFTER CAROTID ENDARTERECTOMY

Abstract

Early postoperative thrombosis-occlusion of the internal carotid artery after carotid endarterectomy plays a major role in postoperative neurologic morbidity and mortality. To prevent this terrible complication, many surgeons are trying various prophylactic methods such as saphenous vein patch angioplasty, prolonged use of heparin, intraoperative Doppler ultrasound assessment, and so on. However, complete protection from postoperative thrombosis-occlusion is difficult. We have performed 47 carotid endarterectomies on 43 patients in the last three years. In 28 of these endarterectomies, primary closure for arteriotomy was performed, and in 19 cases, endarterectomies were reconstructed with saphenous vein patch angioplasty. An intraoperative angiographical assessment of the reconstructed segment was done in all endarterectomies after the reversing of heparin given during the carotid arterial surgical maneuver, and restenosis, or thrombosis-occlusion, was also checked. In three arteries, restenosis was demonstrated and repair was performed with vein graft angioplasty. Three of 28 arteries recontructed with primary closure and 1 of 19 arteries with vein patch angioplasty showed thrombosis-occlusion. Although vein patch angioplasty was done immediately for the primarily closured arteries, occlusion occurred again in two arteries. One artery with patch angioplasty also reoccluded. For these arteries, saphenous vein graft bridging between common carotid artery with an intact intima and internal carotid artery with an intact intima was performed. Postoperative angiogram showed good blood flow through the vein graft bridge. These results suggest that intraoperative angiography gives important imformation about the reconstructed arterial segment and that saphenous vein bridging is very useful in arteries with thrombosis-occlusion following carotid endarterectomy.