Early and late results of biosynthetic ovine carotid angioplasty.

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.