Outcomes of Double-layered, Everted Cervical Vein Patch after Carotid Endarterectomy

Objectives: The objectives of this study were to evaluate the medium-term outcomes in a double-layered, everted cervical vein patch in carotid endarterectomy (CEA). Materials and Methods: This was a single-center, observational study. Retrospective analysis of prospectively collected data was done. All patients with symptomatic internal carotid stenosis who reported to our center and underwent CEA with everted cervical vein patch were retrospectively evaluated for neurological events and patch-related and local complications over a 6-year period. Inclusion criteria included patients who were low surgical risk and willing for operative intervention along with the presence of a minimum 3 mm neck vein with good distensibility (posthydrostatic dilatation) intraoperatively. The primary endpoint was occurrence of any neurologic event (transient ischemic attack and fatal or disabling stroke) at any time during follow-up. The secondary endpoints included stroke-free survival, 30-day and long-term mortality, recurrent stenosis rate (>50%), occlusion, patch infection, aneurysm formation, and other local complications. Results: Between April 2012 and December 2018, 52 patients underwent carotid intervention for symptomatic carotid stenosis at our center. Forty-three patients underwent CEA for various symptomatologies. There were 40 males and 3 females. All male patients were smokers, while females did not give a history of any smoking. The median age was 76 years (95% confidence interval: 73.2–78.3). Comorbidities included diabetes mellitus, hypertension, dyslipidemia, and coronary artery disease (symptomatic and asymptomatic). Thirty-two patients had left-sided involvement, while the right side was involved in 11 cases. There were two perioperative mortalities. The remaining 43 patients were followed up for 6 years. There were no neurological events for the ipsilateral side, and the stroke-free survival was 100%. Conclusion: Double-layered, everted cervical vein is an efficacious, autologous alternative to various other patches in CEA.