Extrathoracic arterial grafts performed for carotid artery occlusive disease not amenable to endarterectomy

Ahmed M. Abou-Zamzam, Gregory (Greg) Moneta, James Edwards, Richard A. Yeager, Donald McConnell, Lloyd M. Taylor, John M. Porter

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Hypothesis: Extrathoracic cervical grafts are safe and provide long- lasting stroke prevention in patients with disease not amenable to standard carotid bifurcation endarterectomy. Design: Review of a prospectively maintained vascular surgical registry. Setting: Combined university and Department of Veterans Affairs vascular surgical service. Participants: Patients requiring surgery for carotid atherosclerotic occlusive disease not amenable to endarterectomy from January 1988 to March 1998. Interventions: Carotid interposition grafting, subclavian-carotid bypass, or carotid-carotid bypass. Main Outcome Measures: Perioperative stroke and death, and life-table determination of freedom from stroke, stroke-free survival, and graft patency. Results: Sixty patients (mean age, 65.8 years; range, 3683) underwent cervically based carotid grafting. All had greater than 70% stenosis or occlusion of the innominate, common carotid, or internal carotid arteries and 30 (50%) had undergone at least 1 previous ipsilateral carotid endarterectomy. Indication for operation was stroke or transient ischemic attack in 46 (77%) and asymptomatic high-grade stenosis in 14 (23%). Operative procedures included 31 (52%) carotid interposition grafts, 18 (30%) subclavian-carotid grafts, and 11 (18%) carotid-carotid grafts. Mean follow- up was 29 months (range, 1-117 months). Perioperative stroke rare was 5% (3/60) all in symptomatic patients, and there were no perioperative deaths. By life-table analysis, freedom from stroke was 92% at 1 and 5 years. Stroke- free survival was 90% at 1 year and 61% at 5 years. Primary graft patency was 94% at 1 year and 84% at 5 years, with assisted primary patency of 90% at 5 years. Conclusion: Cervical carotid artery grafts for complicated or recurrent carotid atherosclerosis not amenable to endarterectomy are durable and provide excellent freedom from stroke with low perioperative morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)952-957
Number of pages6
JournalArchives of Surgery
Volume134
Issue number9
DOIs
StatePublished - Sep 1999

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Endarterectomy
Carotid Artery Diseases
Stroke
Transplants
Life Tables
Carotid Endarterectomy
Blood Vessels
Pathologic Constriction
Transient Ischemic Attack
Operative Surgical Procedures
Internal Carotid Artery
Veterans
Graft Survival
Carotid Arteries
Registries
Outcome Assessment (Health Care)
Morbidity
Survival
Mortality

ASJC Scopus subject areas

  • Surgery

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Extrathoracic arterial grafts performed for carotid artery occlusive disease not amenable to endarterectomy. / Abou-Zamzam, Ahmed M.; Moneta, Gregory (Greg); Edwards, James; Yeager, Richard A.; McConnell, Donald; Taylor, Lloyd M.; Porter, John M.

In: Archives of Surgery, Vol. 134, No. 9, 09.1999, p. 952-957.

Research output: Contribution to journalArticle

Abou-Zamzam, Ahmed M. ; Moneta, Gregory (Greg) ; Edwards, James ; Yeager, Richard A. ; McConnell, Donald ; Taylor, Lloyd M. ; Porter, John M. / Extrathoracic arterial grafts performed for carotid artery occlusive disease not amenable to endarterectomy. In: Archives of Surgery. 1999 ; Vol. 134, No. 9. pp. 952-957.
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abstract = "Hypothesis: Extrathoracic cervical grafts are safe and provide long- lasting stroke prevention in patients with disease not amenable to standard carotid bifurcation endarterectomy. Design: Review of a prospectively maintained vascular surgical registry. Setting: Combined university and Department of Veterans Affairs vascular surgical service. Participants: Patients requiring surgery for carotid atherosclerotic occlusive disease not amenable to endarterectomy from January 1988 to March 1998. Interventions: Carotid interposition grafting, subclavian-carotid bypass, or carotid-carotid bypass. Main Outcome Measures: Perioperative stroke and death, and life-table determination of freedom from stroke, stroke-free survival, and graft patency. Results: Sixty patients (mean age, 65.8 years; range, 3683) underwent cervically based carotid grafting. All had greater than 70{\%} stenosis or occlusion of the innominate, common carotid, or internal carotid arteries and 30 (50{\%}) had undergone at least 1 previous ipsilateral carotid endarterectomy. Indication for operation was stroke or transient ischemic attack in 46 (77{\%}) and asymptomatic high-grade stenosis in 14 (23{\%}). Operative procedures included 31 (52{\%}) carotid interposition grafts, 18 (30{\%}) subclavian-carotid grafts, and 11 (18{\%}) carotid-carotid grafts. Mean follow- up was 29 months (range, 1-117 months). Perioperative stroke rare was 5{\%} (3/60) all in symptomatic patients, and there were no perioperative deaths. By life-table analysis, freedom from stroke was 92{\%} at 1 and 5 years. Stroke- free survival was 90{\%} at 1 year and 61{\%} at 5 years. Primary graft patency was 94{\%} at 1 year and 84{\%} at 5 years, with assisted primary patency of 90{\%} at 5 years. Conclusion: Cervical carotid artery grafts for complicated or recurrent carotid atherosclerosis not amenable to endarterectomy are durable and provide excellent freedom from stroke with low perioperative morbidity and mortality.",
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AU - Abou-Zamzam, Ahmed M.

AU - Moneta, Gregory (Greg)

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AU - Yeager, Richard A.

AU - McConnell, Donald

AU - Taylor, Lloyd M.

AU - Porter, John M.

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N2 - Hypothesis: Extrathoracic cervical grafts are safe and provide long- lasting stroke prevention in patients with disease not amenable to standard carotid bifurcation endarterectomy. Design: Review of a prospectively maintained vascular surgical registry. Setting: Combined university and Department of Veterans Affairs vascular surgical service. Participants: Patients requiring surgery for carotid atherosclerotic occlusive disease not amenable to endarterectomy from January 1988 to March 1998. Interventions: Carotid interposition grafting, subclavian-carotid bypass, or carotid-carotid bypass. Main Outcome Measures: Perioperative stroke and death, and life-table determination of freedom from stroke, stroke-free survival, and graft patency. Results: Sixty patients (mean age, 65.8 years; range, 3683) underwent cervically based carotid grafting. All had greater than 70% stenosis or occlusion of the innominate, common carotid, or internal carotid arteries and 30 (50%) had undergone at least 1 previous ipsilateral carotid endarterectomy. Indication for operation was stroke or transient ischemic attack in 46 (77%) and asymptomatic high-grade stenosis in 14 (23%). Operative procedures included 31 (52%) carotid interposition grafts, 18 (30%) subclavian-carotid grafts, and 11 (18%) carotid-carotid grafts. Mean follow- up was 29 months (range, 1-117 months). Perioperative stroke rare was 5% (3/60) all in symptomatic patients, and there were no perioperative deaths. By life-table analysis, freedom from stroke was 92% at 1 and 5 years. Stroke- free survival was 90% at 1 year and 61% at 5 years. Primary graft patency was 94% at 1 year and 84% at 5 years, with assisted primary patency of 90% at 5 years. Conclusion: Cervical carotid artery grafts for complicated or recurrent carotid atherosclerosis not amenable to endarterectomy are durable and provide excellent freedom from stroke with low perioperative morbidity and mortality.

AB - Hypothesis: Extrathoracic cervical grafts are safe and provide long- lasting stroke prevention in patients with disease not amenable to standard carotid bifurcation endarterectomy. Design: Review of a prospectively maintained vascular surgical registry. Setting: Combined university and Department of Veterans Affairs vascular surgical service. Participants: Patients requiring surgery for carotid atherosclerotic occlusive disease not amenable to endarterectomy from January 1988 to March 1998. Interventions: Carotid interposition grafting, subclavian-carotid bypass, or carotid-carotid bypass. Main Outcome Measures: Perioperative stroke and death, and life-table determination of freedom from stroke, stroke-free survival, and graft patency. Results: Sixty patients (mean age, 65.8 years; range, 3683) underwent cervically based carotid grafting. All had greater than 70% stenosis or occlusion of the innominate, common carotid, or internal carotid arteries and 30 (50%) had undergone at least 1 previous ipsilateral carotid endarterectomy. Indication for operation was stroke or transient ischemic attack in 46 (77%) and asymptomatic high-grade stenosis in 14 (23%). Operative procedures included 31 (52%) carotid interposition grafts, 18 (30%) subclavian-carotid grafts, and 11 (18%) carotid-carotid grafts. Mean follow- up was 29 months (range, 1-117 months). Perioperative stroke rare was 5% (3/60) all in symptomatic patients, and there were no perioperative deaths. By life-table analysis, freedom from stroke was 92% at 1 and 5 years. Stroke- free survival was 90% at 1 year and 61% at 5 years. Primary graft patency was 94% at 1 year and 84% at 5 years, with assisted primary patency of 90% at 5 years. Conclusion: Cervical carotid artery grafts for complicated or recurrent carotid atherosclerosis not amenable to endarterectomy are durable and provide excellent freedom from stroke with low perioperative morbidity and mortality.

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