Randomized trial of vein versus Dacron patching during carotid endarterectomy: Influence of patch type on postoperative embolization
Randomized trial of vein versus Dacron patching during carotid endarterectomy: Influence of patch type on postoperative embolization
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DOI：
10.1067/mva.2001.115005
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发表时间：
2001-05-01
影响因子：
4.3
通讯作者：
Naylor, AR
中科院分区：
文献类型：
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作者：
Hayes, PD;Allroggen, H;Naylor, AR
目的：最近的一项综述表明，尽管颈动脉内膜切除术（CEA）后常规补片比常规一期缝合更安全，但没有系统证据表明补片类型影响结果。然而，大多数外科医生仍然认为人工补片可能比静脉补片更易形成血栓。本研究测试的假设，有没有不同的补丁types.Methods之间的致血栓性差异：共274例患者接受276 CEA被随机分配到任何Dacron补丁关闭（n = 137）或静脉补丁关闭（n = 139）。术后3 h经颅多普勒（TCD）监测颅窗开放情况。栓塞的数量和栓塞率被量化，要求选择性葡聚糖治疗以控制术后栓塞的高发生率。所有患者在术后30天再次进行评估，由神经科医生，所有患者进行了双重检查，在30 days.Results：30天死亡/任何中风率为2.2%的患者在Dacron补丁组和3.6%的患者在静脉补丁组（P = 0.72）。Dacron补片组患者的术后栓塞发生率（中位数，5;四分位数间距，0-10.5）高于静脉补片组患者（中位数，3;四分位数间距，1-17; P = 0.028）。然而，检测到超过50个栓塞的发生率几乎相同，并且补片类型对需要葡聚糖治疗的高比率持续栓塞的发生率没有影响（涤纶为5.3%，静脉为3.7%）。没有病人有颈动脉血栓形成在30 days.Conclusion：持续，高速率栓塞，以前被证明是高度预测颈动脉血栓形成的进展，似乎是患者依赖性的，而不是相关的补丁类型。
Purpose: A recent overview indicated that although routine patching is safer than routine primary closure after carotid endarterectomy (CEA), there is no systematic evidence that patch type influences outcome. However, most surgeons still believe that prosthetic patches are probably more thrombogenic than vein patches. This study tested the hypothesis that there was no difference in thrombogenicity between the different patch types.Methods: A total of 274 patients undergoing 276 CEAs were randomized to either Dacron-patch closure (n = 137) or vein-patch closure (n = 139). All patients with an accessible cranial window were monitored for 3 hours postoperatively with transcranial Doppler scanning (TCD). The number of emboli and rate of embolization were quantified with the requirement for selective dextran therapy to control high rates of postoperative embolization. All patients were assessed postoperatively and again at 30 days by a neurologist, and all patients underwent a duplex examination at 30 days.Results: The 30-day death/any stroke rate was 2.2% for patients in the Dacron-patch group and 3.6% for patients in the vein-patch group (P = .72). Patients in the Dacron-patch group had a higher incidence of postoperative emboli (median, 5; interquartile range, 0-10.5) than patients in the vein-patch group (median, 3; interquartile range, 1-17; P = .028). However, the incidence of detecting more than 50 emboli was virtually identical, and patch type had no effect on the incidence of high-rate, sustained embolization that required dextran therapy (5.3% for Dacron, 3.7% for vein). No patient had a carotid thrombosis at 30 days.Conclusion: Sustained, high-rate embolization, previously shown to be highly predictive of progression to carotid thrombosis, appears to be patient dependent, rather than related to patch type.