[Repeat prosthetic repair of the internal carotid artery]. / Operatsiia povtornogo protezirovaniia vnutrennei sonnoi arterii.

Described herein is a clinical case report regarding reoperation on carotid arteries for thrombosis of a synthetic graft of the internal carotid artery in a patient presenting with a multifocal atherosclerotic lesion. Despite medicamentous treatment carried out after the primary operation, the presence of major risk factors had unfavourably contributed to progression of the disseminated atherosclerotic process. During eight years, the patient had endured reconstructive interventions on the brachiocephalic and coronary arteries, as well as on the vessels of the iliac-femoral-popliteal segment. Taking into consideration the peculiarities of the vascular anatomy, the degree of stenosis of the internal carotid artery with the presence of thrombotic masses in the lumen, and thrombosis inside the graft, a decision was made to perform repeat "open" reconstruction consisting in successful common carotid-internal carotid prosthetic repair using a synthetic graft with resection of the external carotid artery.

[Does the method of carotid reconstruction influence the outcomes of the intervention?].

AIM: to carry out comparative assessment of the immediate outcomes of eversion carotid endarterectomy, classical carotid endarterectomy and prosthetic repair of the internal carotid artery in atherosclerotic-genesis stenoses thereof. MATERIAL AND METHODS: the study was based on a retrospective analysis of the immediate results of 630 isolated primary open interventions on the bifurcation of the common carotid artery in atherosclerosis, performed at the Department of Vascular Surgery of the A.V. Vishnevsky Institute of Surgery over the period from January 2008 to December 2010. The choice of the method of intervention was based on the indications developed worked out at our Department with due regard for the clinical and morphological peculiarities of the lesion of the carotid bifurcation. RESULTS: the incidence of performing eversion carotid endarterectomy (416; 66%) in the entire group was significantly higher than that of classical carotid endarterectomy (127; 20%) and that of prosthetic repair of the internal carotid artery (87; 14%) (p=0.000). Thrombosis of the reconstructed internal carotid artery developed significantly more often (p<0.05) after prosthetic repair (4.6%) and classical carotid endarterectomy (3.9%) as compared with the eversion technique (0.7%). Frequency of the development of homolateral stroke after prosthetic repair of the internal carotid artery (4.6%) was higher than after eversion carotid endarterectomy (1.2%) and classical carotid endarterectomy (2.36%), however, these differences were statistically significant only when compared with the group of the eversion technique (p=0.000). All techniques were accompanied by low mortality from stroke (the eversion technique - 0.24%, classical carotid endarterectomy (0%), prosthetic repair of the internal carotid artery - 1.15%), and the groups did not differ significantly by this parameter (p>0.05). CONCLUSION: the choice of the method of carotid endarterectomy should be determined by the character of lesions of the carotid bifurcation, anatomical interrelationships in the operation wound, and tolerance of the brain to clamping of carotid arteries. Eversion carotid endarterectomy, once possible to perform, is the most preferable method of reconstruction in atherosclerotic lesions of the carotid bifurcation.