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 language | English (US) |
|---|---|
| Pages (from-to) | 952-957 |
| Number of pages | 6 |
| Journal | Archives of Surgery |
| Volume | 134 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1999 |
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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 journal › Article
}
TY - JOUR
T1 - Extrathoracic arterial grafts performed for carotid artery occlusive disease not amenable to endarterectomy
AU - Abou-Zamzam, Ahmed M.
AU - Moneta, Gregory (Greg)
AU - Edwards, James
AU - Yeager, Richard A.
AU - McConnell, Donald
AU - Taylor, Lloyd M.
AU - Porter, John M.
PY - 1999/9
Y1 - 1999/9
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.
UR - http://www.scopus.com/inward/record.url?scp=0344980128&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0344980128&partnerID=8YFLogxK
U2 - 10.1001/archsurg.134.9.952
DO - 10.1001/archsurg.134.9.952
M3 - Article
C2 - 10487589
AN - SCOPUS:0344980128
VL - 134
SP - 952
EP - 957
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 9
ER -