[Resection graft prosthesis (PTFE) of the carotid bifurcation (RGPCB). A new alternative to endarterectomy or to venous bypasses for the treatment of cervical carotid atheromatous stenoses. Technique and indications].

Carotid endarterectomy, possibly followed by an enlarging angioplasty using a venous patch or a prosthesis, is standard treatment for cervical atheromatous lesions. However, this technique may be impossible to apply and a bypass operation may be necessary. J.M. Cormier has proposed the use of a venous by-pass by autologous internal saphenous graft as an alternative to endarterectomy, and reported very favorable results. The usual procedure is lateral implantation into common carotid artery followed by end-to-end implantation into internal carotid artery. The object of this paper is to demonstrate the interest of total resection of the pathologic carotid artery bifurcation followed by total replacement with a prosthesis in PTFE (Goretex) with bifurcated thin walls (new bifurcation constructed by the surgeon) and 3 end-to-end anastomoses (common carotid proximally and internal and external carotids distally). This repair procedure is simple, orthoanatomic, and complete, ensuring permeability of the two axes, internal and external, and is logical. It avoids the thrombo-embolic risk related to the walls after endarterectomy which are often imperfectly smooth leaving a distal intimal projection difficult to prevent or to fix. This thrombotic in situ risk of the endarterectomized wall is shown by isotopic studies with Indium 111-labelled platelets, and most secondary neurologic accidents, definitive, sometimes fatal, or transient, are due to this phenomenon. The three anastomoses in healthy zones considerably reduces this risk. The use of PTFE in femorodistal bypass surgery has been shown to give a good level of long-term permeability even for poor distal beds, and to present a low septic risk compared with Dacron prosthesis. This material was therefore considered a good alternative to a venous graft for the carotid vessels. The technique was used 12 times in 11 patients, between 1984 and 1985, without occlusion, or mortality. One patient developed a transient ischemic accident related to a low output and with multiple pedicles lesions, but there were no sequelae. All shunts were seen to be permeable on follow up venous angiography. Wider experience and a longer review period are necessary before proposing this method, but initial results of its use have been encouraging.