Technical Refinements in Complex Carotid Artery Stenosis: A Bypass Using the Great Saphenous Vein Prepared with "No Touch" Technique Instead of Endarterectomy

Le résumé fourni par la source

Background: Carotid artery surgery in cases with complex carotid artery stenosis is challenging. In these cases, a bypass procedure could be performed as an alternative surgical method to endarterectomy. This study aims to describe the bypass method using the great saphenous vein prepared with the “no touch” technique, and presents early and mid-term clinical outcomes of this technique as an alternative method in the surgical treatment of significant and complex carotid artery stenosis. Methods: A total of 58 patients with complex carotid artery stenosis undergoing carotid artery surgery using the described bypass technique for significant and complex carotid artery stenosis between January 2022 and October 2024 at our center were included in this study. Preoperative basic clinical characteristics, operative data, postoperative outcomes, and complications of the patients were recorded and prospectively analyzed. Results: The mean age of the patients was 64.5 ± 8.6 years (range, 45–84 years). The mean intraoperative carotid clamp duration was 18.6 ± 4.0 min (range, 12–35 minutes). The mean total operation duration was 71.5 ± 18.1 min (range, 45–135 minutes). The mean duration of hospital stay was 2.7 ± 0.9 days (range, 1–6 days). In the early postoperative period, hematoma was observed in four cases, transient hoarseness in four cases, and transient ischemic attack in two cases. In contrast, a major complication or mortality was observed in none of the cases. In the follow-up period, which ranged from 1 to 33 months (mean, 16.6 months), significant internal carotid artery restenosis (>50%) was observed in only one case, whereas no aneurysm formation or late mortality was noted in any of the cases. Conclusions: We suggest that the bypass method, which employs the great saphenous vein prepared using the “no touch” technique, offers a promising alternative for the surgical treatment of complex carotid artery lesions, and in selected cases, particularly those involving high cervical bifurcations or elongated plaques.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.