Aburahma Ali F
Department of Surgery, Faculty of Surgery, West Virginia University, Charleston, WV, USA -
J Cardiovasc Surg (Torino). 2023 Apr;64(2):174-183. doi: 10.23736/S0021-9509.23.12618-8. Epub 2023 Feb 6.
The type of closure after carotid endarterectomy (CEA), whether with patching primary closure or eversion resulting optimal results, remains somewhat controversial. We conducted a PubMed literature review search comparing CEA with patching versus CEA with primary closure versus eversion CEA over the past four decades with emphasis on randomized controlled trials and systematic/meta-analysis and large single center or multicenter studies. The data showed that routine carotid patching can be recommended over primary closure (level 1 evidence); however, CEA with primary closure can be used for large internal carotid arteries (ICAs)>6 mm. Moreover, selective patching with CEA lacks level 1 evidence support. No significant differences were noted among the various patch materials used (e.g., synthetic patches like dacron, ACUSEAL, PTFE, pericardial patches and vein patches) and in the stroke/death rates between eversion carotid endarterectomy (ECEA) and conventional CEA (CCEA) with patching. In addition, no significant restenosis rates were noted between CEA with patching and ECEA; however, CEA with primary closure had higher late restenosis rates. There is level 1 evidence to support CEA with patching or eversion over primary closure and there is also no significant difference between the use of various patches.
颈动脉内膜切除术（CEA）后的闭合方式，无论是采用补片修补、一期缝合还是外翻缝合，哪种能产生最佳效果，仍存在一定争议。我们在PubMed上进行了文献综述搜索，比较了过去四十年来采用补片修补的CEA、一期缝合的CEA和外翻缝合的CEA，重点关注随机对照试验、系统评价/荟萃分析以及大型单中心或多中心研究。数据表明，与一期缝合相比，推荐常规使用颈动脉补片（1级证据）；然而，对于内径大于6mm的颈内动脉（ICA），可采用一期缝合的CEA。此外，CEA选择性补片缺乏1级证据支持。在使用的各种补片材料（如涤纶、ACUSEAL、聚四氟乙烯等合成补片、心包补片和静脉补片）之间，以及外翻颈动脉内膜切除术（ECEA）和采用补片修补的传统CEA（CCEA）之间的卒中/死亡率方面，未发现显著差异。此外，补片修补的CEA和ECEA之间的再狭窄率也无显著差异；然而，一期缝合的CEA晚期再狭窄率较高。有1级证据支持补片修补或外翻缝合的CEA优于一期缝合，并且使用各种补片之间也无显著差异。
