Carotid endarterectomy with internal carotid artery segmental resection, temporary shunt and vein patch angioplasty:: early and mid-term results

Aim. The authors report an alternative procedure to carotidendarterectorny with internal carotid artery (ICA) segmental resection and end-to-end anastomosis associated with temporary shunt and venous patch angioplasty. Design: prospective cohort study. Methods. Between May 1995 and December 2004, 192 patients underwent 200 primary CEAs for significant ICA stenosis. There were 131 men and 61 women with a mean,age of 72.4 +/- 8.4 years. The indications for CEA were asymptomatic lesions in 51.5%, transient ischemic attack in 27.5% and stroke in 21%. Results. The combined early morbidity and mortality rate was 2%. Two patients died, one due to fatal intracerebral hemorrhage and the second patient died of acute mesenteric ischemia. Neurological complications occurred in 2 patients, including I TIA and I nondisabling cerebrovascular accident. Non-neurological complications occurred in 26 patients (13.5%). Seventeen patients (8.8%) developed hypertension, 3 neck hematomas (1.5%) required surgical,evacuation, 1 patient had reversible supraventricular,arrhythmia (0.5%) and I patient had pneumonia (0.5%). Furthermore, I asymptomatic carotid occlusion was identified (0.5%) and 3 patients suffered permanent cranial nerve injury (1.5%). Mean follow-up was 45.7 months and there were 41 late deaths (21.8%). Survival rates at 1 and 5 years were 96.7 +/- 1.2% and 73.58 +/- 4.2%, respectively. Conclusions. CEA with ICA shortening and reanastomosis is a safe and reliable procedure without any increase in morbidity or mortality.