Ladowski Joseph M, Ladowski Joseph S
Indiana/Ohio Heart Cardiothoracic and Vascular Surgeons, Ft. Wayne, Indiana, USA.
Ann Vasc Surg. 2011 Jul;25(5):646-50. doi: 10.1016/j.avsg.2010.11.008. Epub 2011 Jan 26.
It has been shown that patch closure after carotid endarterectomy (CEA) decreases the rate of recurrent stenosis. This study was designed to evaluate the utility of bovine pericardium patch as an option for patch closure after CEA.
This retrospective study examined 845 CEAs with bovine patch closure that were performed by the surgeons of Indiana-Ohio Heart, Fort Wayne, IN, between May 2003 and March 2009. The average age of the patients was 72.7 ± 10.6 years and postoperative follow-up was performed using duplex ultrasound at (ideally) 1 month, 6 months, 12 months, and annually thereafter. The average duration of follow-up for this study was 19.2 ± 16.8 months (ranging from 1 day to 72 months). All patients were evaluated for demographics and postoperative medications. Restenosis was categorized in three ways: nonsignificant (0-59% narrowing of the artery), significant (60-79%), or critical (80-99%). A total of 796 arteries were studied at least once during the postoperative period.
None of the postoperative duplex studies revealed occlusion of the endarterectomized artery. At the mean follow-up duration, 323 endarterectomized arteries were studied. In all, 24 arteries (7.43%) had significant stenosis and only two (0.62%) had critical stenosis. These numbers compare favorably with the recurrent restenosis rates of other materials. Additionally, the effect of statins on restenosis rates was studied. We were unable to demonstrate a beneficial effect of postoperative statin therapy on restenosis rates.
The use of bovine pericardium for patch closure in CEA yields excellent freedom from residual or recurrent postoperative stenosis and the use of statins postoperatively failed to reduce the likelihood of residual or recurrent stenosis.
已表明颈动脉内膜切除术（CEA）后使用补片封闭可降低再狭窄率。本研究旨在评估牛心包补片作为CEA后补片封闭选择的效用。
这项回顾性研究检查了2003年5月至2009年3月期间印第安纳州韦恩堡的印第安纳 - 俄亥俄心脏中心的外科医生进行的845例采用牛心包补片封闭的CEA手术。患者的平均年龄为72.7±10.6岁，术后随访（理想情况下）在1个月、6个月、12个月进行，之后每年进行一次双功超声检查。本研究的平均随访时间为19.2±16.8个月（范围从1天至72个月）。对所有患者进行人口统计学和术后用药评估。再狭窄分为三种情况：不显著（动脉狭窄0 - 59%）、显著（60 - 79%）或严重（80 - 99%）。术后期间共对796条动脉进行了至少一次研究。
术后双功超声检查均未显示内膜切除动脉闭塞。在平均随访期间，对323条内膜切除动脉进行了研究。总共有24条动脉（7.43%）有显著狭窄，只有两条（0.62%）有严重狭窄。这些数字与其他材料的再狭窄率相比很有利。此外，研究了他汀类药物对再狭窄率的影响。我们未能证明术后他汀类药物治疗对再狭窄率有有益作用。
在CEA中使用牛心包进行补片封闭可使术后极好地避免残留或再发狭窄，且术后使用他汀类药物未能降低残留或再发狭窄的可能性。
