[Internal carotid artery surgery using a venous graft].

Thromboendarterectomy is the most popular technique of carotid restoration for atheromatous lesions. In some cases, endarterectomy may be difficult or hazardous to perform, when atherosclerotic lesions involve the proximal common carotid artery and/or the distal internal carotid artery, when they are radiation induced, and when they are associated with fibromuscular dysplasia, loops or kinking. In other cases, result of endarterectomy may be unsatisfactory, because of a traumatic lesion of the arterial wall during endarterectomy, or a stenosis of the arteriotomy closure. Postoperative and late restenosis and occlusion rate range between 10 and 50% after primary closure of the carotid arteriotomy. Some of these complications may be reduced by alternative techniques such as eversion endarterectomy or patch angioplasty closure. Reversed saphenous bypass may also be performed. In our experience, only suitable autologous greater saphenous vein shall be harvested, including adequate length, absence of valves, diameter greater than 4 mm, and excellent wall texture. Distal anastomosis on the internal carotid artery shall be performed end-to-side with ligation of the internal carotid stump, and not end-to-end. Thus, in that location, venous grafts have excellent long-term patency with less than 5% late restenosis or occlusion rate. Thus, venous graft bypass may be an alternative technique to carotid endarterectomy, especially in young patients and women, who are more often exposed to late complications.