Prospective randomized study of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated Dacron (Hemashield) patching: Perioperative (30-day) results
Prospective randomized study of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated Dacron (Hemashield) patching: Perioperative (30-day) results
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DOI：
10.1067/mva.2002.119034
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发表时间：
2002-01-01
影响因子：
4.3
通讯作者：
Davis, EA
中科院分区：
文献类型：
--
作者：
AbuRahma, AF;Hannay, RS;Davis, EA
目的：几项研究报道了颈动脉内膜切除术（CEA）和补片血管成形术的结果上级初次闭合。聚四氟乙烯（PTFE）补片已被证明具有与自体静脉补片相当的结果;然而，它需要延长止血时间。因此，许多外科医生正在使用胶原浸渍的涤纶补片（Hemashield [HP]）。这项研究是第一个前瞻性随机试验比较CEA与PTFE patterning与HP patterning.Methods：200例CEA被随机分为两组，100例PTFE和100例HP patterning。所有患者均接受术后即刻和术后1个月的彩色多普勒超声扫描研究。两组的人口统计学和临床特征相似，包括颈内动脉的平均手术直径。结果：PTFE的围手术期卒中率为0%，而HP为7%（4例大卒中和3例小卒中，P = 0.02）。PTFE组围手术期卒中和短暂性脑缺血发作的合并发生率为3%，而HP组为12%（P = 0.047）。PTFE的手术死亡率为0%，而HP为2%（P = 0.477）。在接受HP修补术的患者中观察到5例围手术期颈动脉血栓形成，而接受PTFE修补术的患者中没有（P = 0.07）。1个月随访后，PTFE组2%的患者发生50%或以上再狭窄，而HP组为12%（P = 0.013）。PTFE修补的平均手术时间为119分钟，HP修补的平均手术时间为113分钟（P = 0.081）。PTFE补片的平均止血时间显著高于HP补片，分别为14.4和3.4分钟（P <0.001）。结论：CEA联合HT补片的围手术期卒中、颈动脉血栓形成和50%或更多的早期再狭窄发生率高于CEA联合PTFE补片。然而，PTFE补片的平均止血时间高于HP补片。
Purpose: Several studies have reported that carotid endarterectomy (CEA) with patch angioplasty has results that are superior to primary closure. Poly-tetra-fluoroethylene (PTFE) patching has been shown to have results comparable with autogenous vein patching; however, it requires a prolonged hemostasis time. Therefore, many surgeons are using collagen- impregnated Dacron patching (Hemashield [HP]). This study is the first prospective randomized trial comparing CEA with PTFE patching versus HP patching.Methods: Two hundred CEAs were randomized into two groups, 100 PTFE and 100 HP patching. All patients underwent immediate postoperative and 1-month postoperative color duplex ultrasound scanning studies. Demographic and clinical characteristics were similar in both groups, including the mean operative diameter of the internal carotid artery.Results: The perioperative stroke rates were 0% for PTFE, versus 7% for HP (4 major and 3 minor strokes, P = .02). The combined perioperative stroke and transient ischemic attack rates were 3% for PTFE, versus 12% for HP (P = .047). The operative mortality rate for PTFE was 0%, versus 2% for HP (P = .477). Five perioperative carotid thromboses were noted in patients undergoing HP patching, versus none in patients undergoing PTFE patching (P = .07). After I month of follow-up, 2% of patients in the PTFE group had a 50% or more restenosis, versus 12% of patients in the HP group (P = .013). The mean operative time for PTFE patching was 119 minutes, versus 113 minutes for HP patching (P = .081). The mean hemostasis time was significantly higher for PTFE patching than for HP patching, 14.4 versus 3.4 minutes (P < .001).Conclusion: CEA with HT patching had a higher incidence of perioperative strokes, carotid thrombosis, and 50% or more early restenosis than CEA with PTFE patching. However, the mean hemostasis time was higher for PTFE patching than for HP patching.