Pratesi C, Pulli R, Michelagnoli S
Department of Vascular Surgery, University of Florence, Italy.
Int Angiol. 1993 Mar;12(1):47-53.
Recent major technical improvements in the field of carotid surgery have been related to anesthesiology and cerebral monitoring. However early embolic events and recurrent stenosis are, after intraoperative ischaemia, the main problems of carotid endarterectomy (CEA) and therefore technical improvements that reduce the incidence of these complications are required. The choice between primary closure and angioplasty is still debated. In the case of angioplasty, the choice of patching material seems to be important in preventing these complications. The Authors present their experience with a biosynthetic ovine patch in carotid surgery. In the period from January 1982 to November 1991, 1013 carotid endarterectomies were performed on 866 patients (659 men, 207 women) with atherosclerotic disease at the carotid bifurcation. In 147 cases a bilateral CEA was performed. Recently, in 37 cases of patch angioplasty, the Authors used the biosynthetic ovine patch. No deaths and no permanent neurological deficit were registered in this series either during awakening or the immediate postoperative period. Of these 37 patients, all except 4, had a minimum follow-up of 24 months. Two cases of non-hemodynamic restenosis were detected, one at 6 and one at 12 months; both were asymptomatic. In this series the total restenosis ratio was 5.5% (2/36), and the cumulative mortality rate 10.8% (4/37) (IMA 2, hepatic insufficiency 1, cerebral hemorrhage 1). The Authors' preliminary experience with this biosynthetic graft as a patching material has been satisfactory. They believe that this biosynthetic graft (Omniflow) on account of its handling and particularly its healing characteristics can be considered as a graft material for patching at the carotid level.
颈动脉手术领域最近的重大技术改进与麻醉学和脑监测有关。然而，除术中缺血外，早期栓塞事件和再狭窄是颈动脉内膜切除术（CEA）的主要问题，因此需要能降低这些并发症发生率的技术改进。一期缝合和血管成形术之间的选择仍存在争议。在血管成形术的情况下，补片材料的选择对于预防这些并发症似乎很重要。作者介绍了他们在颈动脉手术中使用生物合成羊补片的经验。在1982年1月至1991年11月期间，对866例（659例男性，207例女性）患有颈动脉分叉处动脉粥样硬化疾病的患者进行了1013例颈动脉内膜切除术。其中147例进行了双侧CEA。最近，在37例补片血管成形术中，作者使用了生物合成羊补片。该系列中在苏醒或术后即刻均未出现死亡及永久性神经功能缺损。在这37例患者中，除4例外，其余均进行了至少24个月的随访。检测到2例非血流动力学再狭窄，1例在6个月时，1例在12个月时；均无症状。该系列中的总再狭窄率为5.5%（2/36），累积死亡率为10.8%（4/37）（心肌梗死2例，肝功能不全1例，脑出血1例）。作者将这种生物合成移植物作为补片材料的初步经验令人满意。他们认为，这种生物合成移植物（Omniflow）由于其操作性能，特别是其愈合特性，可被视为颈动脉水平补片的移植物材料。
