Patch angioplasty with vein or Dacron may be required to prevent narrowing when the arteriotomy is closed following carotid endarterectomy. We studied the effect of such patches on intraluminal thrombus formation by measuring radiolabelled platelet uptake in patients following simple closure and patch angioplasty.Following unilateral carotid endarterectomy in 33 patients, the arteriotomy was closed by direct suture in 23, Dacron patch in 6 and saphenous vein patch in 4. Autologous 111In-platelets were infused on the second postoperative day and platelet uptake over the carotid measured on daily gamma camera images for 3 days. Radioactivity over the operated and contralateral carotids were compared as the Carotid Uptake Ratio.Mean (±sem) counts per gamma camera cell at 24 hours in the operated carotid of 43.6±3.0 were consistently higher than the reference artery of 35.4±2.4 (p<0.001). The overall carotid uptake ratio was 1.21±0.04 with that of 1.41±0.07 in patch angioplasty significantly higher than 1.14±0.04 found following standard arteriotomy closure (p<0.01). All 10 patch angioplasties were easily visible as "hot spots" on gamma camera compared to only 11 out of 23 with simple closure but there was no significant difference between platelet uptake with vein or Dacron patches with ratios of 1.47±0.35 and 1.37±0.15 respectively (p>0.5).The greater local platelet accumulation with patch angioplasty may be due to turbulence from excessive widening of the vessel combined with the thrombogenic surface following endarterectomy. Until the significance of platelet accumulation is established platelet inhibitory therapy should be considered when patch closure is unavoidable.
Durability of eversion carotid endarterectomy: Comparison with primary closure and carotid patch angioplasty
