Complication Rate after Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure

Background: Carotid endarterectomy (CEA) reduces the risk for stroke in patients with internal carotid artery stenosis. The optimal surgical technique remains subject of debate. Literature suggests patch angioplasty reduces complication risk. However, primary closure shortens cross-clamp times and eliminates graft-specific complications. This study aimed to assess complication rate after CEA with selective patching. Methods: A total of 213 consecutive CEAs over a 3-year period from January 5th, 2011 to December 19th, 2013 were retrospectively analyzed. Postoperative complications were evaluated within 1 month after surgery. Results: Primary closure was used in 110 operations and patch angioplasty in 103 procedures. Primary closure was performed when the carotid artery had a diameter above 5 mm, when there was a high carotid bifurcation, and when the contralateral carotid artery was occluded. After primary closure, we found 4 (3.6%) complications: 2 (1.8%) bleeding and 2 (1.8%) cranial nerve damage. After patch angioplasty 5 (4.9%) complications occurred: 1 (1.0%) bleeding, 2 (1.9%) cranial nerve damage, 1 (1.0%) cerebrovascular event, and 1 (1.0%) cerebral hyperperfusion resulting in mortality. There was no higher complication risk after primary closure (P = 0.68). Clamp time was significantly longer when using patch angioplasty (P < 0.001). Conclusions: Primary closure appears to be an equivalent closure technique compared with patch angioplasty when used in selected patients.