Carotid artery bifurcation advancement: an alternative to patching.

Carotid bifurcation advancement uses the in situ external carotid artery to patch the internal carotid after carotid endarterectomy. This avoids the potential complications of patch rupture and pseudo-aneurysm formation seen with vein and synthetic patches. In 25 cases a Dacron patch was used to close and nine bifurcation advancement closures were compared retrospectively with 30 cases using simple primary closure and 13 using a saphenous vein patch. Follow-up with carotid duplex scanning revealed six restenoses > 50% in the primary closure group, whereas the patch angioplasty and bifurcation advancement groups had no restenoses (P = 0.002). No significant difference in post-endarterectomy flow increase was shown between the patch angioplasty groups and the bifurcation advancement group. Operation times did not differ significantly between the patch closure and the bifurcation advancement groups. Carotid bifurcation advancement is an alternative method of vessel closure with comparable rates of restenosis, post-endarterectomy flow increase, and operation time as compared with conventional patch angioplasty closure techniques.