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首页> 外文期刊>Vascular surgery >Prospective controlled study of carotid endarterectomy with hemashield patch: is it thrombogenic?
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Prospective controlled study of carotid endarterectomy with hemashield patch: is it thrombogenic?

机译：颈前动脉内膜切除术与肝罩修补术的前瞻性对照研究：它是否具有血栓形成作用？

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The use of patch angioplasty after carotid endarterectomy (CEA) has been shown to have superior results to CEA with primary closure. Polytetrafluoroethylene (PTFE) patches have been shown to have comparable results to autogenous vein patching; however, PTFE has the disadvantage of prolonged hemostasis time. Therefore, many surgeons are using collagen-impregnated Dacron patches (Hemashield(trade mark) [HP]). We believe this is the first prospective controlled study of the use of HP in carotid endarterectomy. This study included 144 consecutive patients who had 151 CEAs with HP. Postoperative duplex ultrasounds were done at 1 month and every 6 months thereafter. The mean follow-up was 12 months (range: 1-30 months). Indications for CEA included symptomatic (64%) and asymptomatic (36%) stenoses. The overall incidence of ipsilateral stroke was 5% (4% perioperative), with a combined TIA and stroke rate of 12%. Incidence of >/=50% recurrent stenosis was 21% (7% symptomatic TIA/stroke) and >/=80% recurrent stenosis was 9%. Kaplan-Meier analysis showed that at 1 year and 2.5 years freedom from >/=50% recurrent stenosis was 78% and 57%, respectively, freedom from >/=80% recurrent stenosis was 92% and 77%, respectively, and a stroke-free survival rate of 94% and 72%, respectively. Women had a 22% and men a 14% recurrent stenosis rate (p=0.04). There was no correlation between other specific risk factors and recurrent stenosis except for hypertension (33% vs 12%, p=0.003). The authors concluded that CEA with HP had a higher incidence of recurrent stenosis (21%), and a higher perioperative stroke rate (4%) after a mean follow-up of 12 months than previously reported using PTFE or saphenous vein patching (2% and 9% recurrent stenosis rates, respectively, and 1% and 0% perioperative stroke rates, respectively after a mean follow-up of 30 months). This raises the question as to whether this patch is thrombogenic in this location. Therefore, a randomized controlled trial comparing this patch with other patches (PTFE or vein) is warranted.
机译：颈动脉内膜切除术（CEA）后使用斑块血管成形术已被证明比原发性闭合术具有更好的效果。聚四氟乙烯（PTFE）贴剂已显示出与自体静脉贴剂可比的结果。但是，PTFE具有止血时间延长的缺点。因此，许多外科医生正在使用胶原蛋白浸渍的涤纶贴片（Hemashield（商标）[HP]）。我们相信这是在颈动脉内膜切除术中使用HP的首个前瞻性对照研究。该研究纳入了144位连续性患者，这些患者接受了151例HP CEA。术后1个月进行超声检查，之后每6个月检查一次。平均随访时间为12个月（范围：1-30个月）。 CEA的适应症包括有症状的狭窄（64％）和无症状的狭窄（36％）。同侧中风的总发生率为5％（围手术期为4％），合并TIA和中风发生率为12％。 ≥50％的复发性狭窄的发生率为21％（有症状的TIA /中风为7％），≥80％的复发性狭窄的发生率为9％。 Kaplan-Meier分析显示，在1年和2.5年时，> / = 50％复发性狭窄的自由度分别为78％和57％，从> / = 80％复发性狭窄的自由度分别为92％和77％，并且无中风生存率分别为94％和72％。女性复发狭窄率为22％，男性狭窄率为14％（p = 0.04）。除高血压外，其他特定危险因素与复发性狭窄之间无相关性（33％vs 12％，p = 0.003）。作者得出的结论是，平均随访12个月后，CEA合并HP的复发狭窄发生率较高（21％），围手术期卒中发生率较高（4％），高于先前报道的使用PTFE或大隐静脉修补术的发生率（2％）。平均随访30个月后，复发狭窄率分别为9％和9％，围手术期中风发生率分别为1％和0％。这引起了关于该贴剂在该位置是否血栓形成的问题。因此，有必要对该贴片与其他贴片（PTFE或静脉）进行比较的随机对照试验。

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