This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Comparison of primary closure with dacron patch angioplasty in early and late restenosis after carotid endarterectomy. BJS 2001; 88: 599-599.
Published: 6th December 2002
Authors: D. J. Gerrard, A. H. Hatrick, R. A. Dourado, H. Patel, A. T. Irvine, K. G. Burnand et al.
Background
The primary closure of carotid arteriotomy has a high incidence of intraoperative residual stenosis following carotid endarterectomy.
Method
Completion angiograms in a consecutive series of 197 patients undergoing carotid endarterectomy were reviewed. All operations were performed under general anaesthesia with routine shunt insertion and middle cerebral artery transcranial Doppler monitoring. The first 117 patients had primary closure of the arteriotomy and the last 80 all had patch closure. An independent radiologist, who was unaware of the procedure performed, randomly assessed the intraoperative angiograms. All patients have been followed by 3‐monthly duplex screening for 1 year. Results were assessed with the χ2 test.
Results
The stroke and death rate of 7 per cent in the primary closure group was significantly higher than the 1 per cent stroke and death rate in the patched group (P < 0·05). Perioperative angiograms scored 0–20 per cent residual stenosis in 75 per cent of the primary closures, compared with 89 per cent in the patched group (P < 0·05). Some 25 per cent of the primary closures were considered unsatisfactory, compared with 11 per cent of the patched closures. Restenosis greater than 50 per cent at 1 year was significantly higher in the primary closure group (33 versus 19 per cent; P < 0·05).
Conclusion
Patch closure results in a better technical result than primary closure, as judged by radiological appearance, and reduces the overall stroke and death rate. Restenosis is significantly lower at 1 year. © 2001 British Journal of Surgery Society Ltd
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