Hertzer N R, Martinez B D, Benjamin S P, Beven E G
Surg Gynecol Obstet. 1979 Sep;149(3):360-4.
Thirteen of 1,250 patients required a second operation for recurrent stenosis following carotid endarterectomy performed at the Cleveland Clinic between 1958 and 1978. Two other patients underwent reoperation because of recurrent stenosis following primary operations at other institutions. Thirteen of the 15 patients experienced neurologic symptoms caused by recurent stenosis, while two patients remained asymptomatic. Atherosclerosis was responsible for recurrent stenosis in 12 patients and appeared to be related to hypercholesterolemia. Three of the patients had myointimal fibroplasia. Eleven of the 16 reoperations for recurrent stenosis of the carotid artery consisted of carotid endarterectomy with vein patch angioplasty. Three patients had carotid endarterectomy with closure of the primary arteriotomy. One patient with occlusion of the internal carotid artery underwent endarterectomy of the external carotid artery because of amaurosis fugax, and a saphenous vein interposition graft was used to replace a previous Dacron graft in one patient with anastomotic stenosis. One patient had a stroke during reoperation manifest as multiple retinal emboli. Fourteen patients have remained asymptomatic from one to 70 months following reoperation. One patient with occlusion of the contralateral internal carotid artery has experienced persistent vertebrobasilar symptoms.
1958年至1978年期间，在克利夫兰诊所接受颈动脉内膜切除术的1250例患者中，有13例因复发性狭窄需要进行二次手术。另外2例患者在其他机构接受初次手术后，因复发性狭窄而接受了再次手术。15例患者中有13例出现了由复发性狭窄引起的神经症状，而2例患者仍无症状。12例患者的复发性狭窄是由动脉粥样硬化引起的，且似乎与高胆固醇血症有关。3例患者患有肌内膜纤维增生。在16例因颈动脉复发性狭窄而进行的再次手术中，11例采用了颈动脉内膜切除术加静脉补片血管成形术。3例患者进行了颈动脉内膜切除术并缝合了初次动脉切开处。1例颈内动脉闭塞的患者因一过性黑矇接受了颈外动脉内膜切除术，1例因吻合口狭窄的患者使用大隐静脉移植血管替换了先前的涤纶移植血管。1例患者在再次手术期间发生中风，表现为多发性视网膜栓塞。14例患者在再次手术后1至70个月一直无症状。1例对侧颈内动脉闭塞的患者出现了持续性椎基底动脉症状。
