Complications resulting from saphenous vein patch graft after carotid endarterectomy

Yoshihiro Yamamoto, David G. Piepgras, W. Richard Marsh, Fredric B. Meyer

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

OBJECTIVE: Reducing surgical risks to the minimum in carotid endarterectomy has become crucial, especially with the results of recent clinical trials extending indications to asymptomatic patients. The use of the saphenous vein patch graft (SVPG) has been suggested to reduce early postoperative thrombosis and cerebral infarct as well as late recurrent stenosis. However, the exact risks and complications involved in this technique are not known. METHODS: During a 23-year period (1972-1994), 2888 carotid endarterectomies with SVPG for primary carotid stenosis were performed by the Neurosurgical Cerebrovascular Service at the Mayo Clinic. The data from all patients were retrospectively analyzed, emphasizing postoperative complications related to SVPG. RESULTS: There were five postoperative vein ruptures (0.17%), four cases of aneurysm formation, and three cases of deep infection necessitating surgical intervention. The vein patch ruptured in one male patient and four female patients (mean age, 69 yr). All ruptures occurred within 4 days of the primary operation, including two during the first 24 hours. All patients with rupture underwent emergency surgery and were found to have intact suture lines and tears in the middle of the grafts. Two patients recovered without deficits, one suffered major disability, and the other two died. Aneurysm of the patch developed in two male patients and two female patients (mean age, 71 yr). All of the patients developed painless pulsatile neck masses 1 to 9 years after the initial surgery; two also had recurrent ischemic symptoms. All of the patients with aneurysms underwent surgical correction without consequences. CONCLUSION: Although the benefit of routine use of SVPG in carotid endarterectomy is still the focus of debate, this analysis showed that its use adds a small but definite risk of serious complications related to inherent weakness of the venous tissue. If a surgeon chooses to use a patch graft, our recommendation is for use of a synthetic material rather than vein.

Original languageEnglish (US)
Pages (from-to)670-676
Number of pages7
JournalNeurosurgery
Volume39
Issue number4
StatePublished - Oct 1996

Fingerprint

Carotid Endarterectomy
Saphenous Vein
Transplants
Aneurysm
Rupture
Veins
Intracranial Thrombosis
Carotid Stenosis
Tears
Sutures
Pathologic Constriction
Emergencies
Neck
Clinical Trials

Keywords

  • Carotid aneurysm
  • Carotid endarterectomy
  • Collagen-impregnated dacron
  • Saphenous vein patch graft
  • Vein patch rupture

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Yamamoto, Y., Piepgras, D. G., Richard Marsh, W., & Meyer, F. B. (1996). Complications resulting from saphenous vein patch graft after carotid endarterectomy. Neurosurgery, 39(4), 670-676.

Complications resulting from saphenous vein patch graft after carotid endarterectomy. / Yamamoto, Yoshihiro; Piepgras, David G.; Richard Marsh, W.; Meyer, Fredric B.

In: Neurosurgery, Vol. 39, No. 4, 10.1996, p. 670-676.

Research output: Contribution to journalArticle

Yamamoto, Y, Piepgras, DG, Richard Marsh, W & Meyer, FB 1996, 'Complications resulting from saphenous vein patch graft after carotid endarterectomy', Neurosurgery, vol. 39, no. 4, pp. 670-676.
Yamamoto Y, Piepgras DG, Richard Marsh W, Meyer FB. Complications resulting from saphenous vein patch graft after carotid endarterectomy. Neurosurgery. 1996 Oct;39(4):670-676.
Yamamoto, Yoshihiro ; Piepgras, David G. ; Richard Marsh, W. ; Meyer, Fredric B. / Complications resulting from saphenous vein patch graft after carotid endarterectomy. In: Neurosurgery. 1996 ; Vol. 39, No. 4. pp. 670-676.
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AB - OBJECTIVE: Reducing surgical risks to the minimum in carotid endarterectomy has become crucial, especially with the results of recent clinical trials extending indications to asymptomatic patients. The use of the saphenous vein patch graft (SVPG) has been suggested to reduce early postoperative thrombosis and cerebral infarct as well as late recurrent stenosis. However, the exact risks and complications involved in this technique are not known. METHODS: During a 23-year period (1972-1994), 2888 carotid endarterectomies with SVPG for primary carotid stenosis were performed by the Neurosurgical Cerebrovascular Service at the Mayo Clinic. The data from all patients were retrospectively analyzed, emphasizing postoperative complications related to SVPG. RESULTS: There were five postoperative vein ruptures (0.17%), four cases of aneurysm formation, and three cases of deep infection necessitating surgical intervention. The vein patch ruptured in one male patient and four female patients (mean age, 69 yr). All ruptures occurred within 4 days of the primary operation, including two during the first 24 hours. All patients with rupture underwent emergency surgery and were found to have intact suture lines and tears in the middle of the grafts. Two patients recovered without deficits, one suffered major disability, and the other two died. Aneurysm of the patch developed in two male patients and two female patients (mean age, 71 yr). All of the patients developed painless pulsatile neck masses 1 to 9 years after the initial surgery; two also had recurrent ischemic symptoms. All of the patients with aneurysms underwent surgical correction without consequences. CONCLUSION: Although the benefit of routine use of SVPG in carotid endarterectomy is still the focus of debate, this analysis showed that its use adds a small but definite risk of serious complications related to inherent weakness of the venous tissue. If a surgeon chooses to use a patch graft, our recommendation is for use of a synthetic material rather than vein.

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