Bufo A J, Shah D M, Chang B B, Leather R P
Vascular Surgery Section, Albany Medical College, New York.
J Cardiovasc Surg (Torino). 1992 May-Jun;33(3):308-10.
Patching of carotid endarterectomies has been advocated as a means of both facilitating secure closure and minimizing recurrent stenosis. Most vascular surgeons occasionally, if not always, patch selected carotid arteries. However, patching requires the surgeon to utilize either prosthetic material (Dacron or PTFE), which is relatively thrombogenic, or autogenous vein, which requires a second operative field and available saphenous vein at the ankle. Bifurcationplasty, otherwise known as bifurcation advancement, has been used as an alternative to patching at our institution over the past four years. This technique, which involves the use of the opened, endarterectomized external carotid artery as an autogenous in-continuity patch for the internal carotid artery, obviates the need for prosthetic materials and saphenous vein alike. This procedure has been performed 30 times over a 4-year period (1987-91). During this time, 280 carotid endarterectomies were performed. A vein patch or Dacron was used in four cases early in this series. Bifurcationplasty was also the procedure of choice for repeat carotid endarterectomy, and was performed in five cases of recurrent stenosis after direct closure. In a follow-up period averaging 22 months (range 1-48), there were no instances of symptomatic restenosis. We feel that bifurcationplasty is an easily performed autogenous alternative to conventional patch closure of the carotid artery.
颈动脉内膜切除术的补片修补术已被提倡作为一种促进安全闭合和最小化再狭窄的手段。大多数血管外科医生即使不总是，也会偶尔对选定的颈动脉进行补片修补。然而，补片修补需要外科医生使用相对易形成血栓的人工材料（涤纶或聚四氟乙烯），或者需要第二个手术区域且踝部有可用大隐静脉的自体静脉。在过去四年中，我们机构采用了分叉成形术，也称为分叉推进术，作为补片修补术的替代方法。该技术涉及使用切开并进行内膜切除的颈外动脉作为颈内动脉的自体连续补片，从而无需人工材料和大隐静脉。在4年期间（1987 - 1991年）共进行了30次该手术。在此期间，共进行了280例颈动脉内膜切除术。在该系列早期的4例中使用了静脉补片或涤纶补片。分叉成形术也是再次颈动脉内膜切除术的首选方法，在直接闭合后出现5例再狭窄的病例中进行了该手术。在平均22个月（范围1 - 48个月）的随访期内，没有出现有症状的再狭窄病例。我们认为分叉成形术是一种易于实施的自体替代方法，可替代传统的颈动脉补片闭合术。
