[Surgical management of occlusive diseases of extracranial arteries].

In 4 years and 4 months (between Sept. 1981 and Dec. 1985) 257 vascular reconstructive operations were performed on 219 cases with an occlusive disease of the extracranial arteries at the Aggeralklinik in West Germany. Perioperative mortality was 0.78%. While in 2 cases out of 6 (33.3%), in which patchplasty was performed, patients suffered from perioperative neurological deficit, in 2 cases out of 251 (0.8%), in which thromboendarterectomy alone was performed, patients suffered from the same. This suggests that patchplasty may develop thrombus formation. Intraoperative thrombus formation in a shunt was observed in 2 cases out of 167 (1.2%). Postoperative restenosis was found in 11 cases (4.3%), in each case in carotid bifurcate lesions. Nine cases indicated intimal fibrosis histologically, namely early restenosis (within 18 months after operation), and the other 2 recurrent atherosclerosis, namely late restenosis (beyond the 18th month after operation). In the 6 cases of the former 9 reoperation by patchplasty was performed and in the latter 2 reoperation by thromboendarterectomy and patchplasty. No significant difference of restenotic rate could be observed between the cases in which patchplasty was performed and those in which thromboendarterectomy alone was performed (16.7% and 4.0%, respectively). Nor did the well-known risk factors of atherosclerosis have any significant relations with the restenotic rate. The future problems are (1) careful application of patchplasty, (2) careful use of a shunt (electroencephalographic monitoring is useful) and (3) explication of the way of recurrence and its prevention. At present, digital subtraction angiography may be useful for the early detection of postoperative restenosis.