Abstract
We examined the value of synthetic patch grafts in patients undergoing carotid endarterectomy (CEA). Patch grafting using a Hemashield was adopted in 22 CEA procedures. Mild hypothermia at 34°C was induced in the patients to reduce the risk of cerebral ischemia during carotid clamping. Monitoring by two kinds of cerebral oximetry was undertaken continuously to evaluate the cerebral blood flow. Cardiac output (CO) was calculated two times during normothermia and at 34°C. Systemic heparinization was induced intraoperatively, and was then continued 5 days postoperatively. The average clamping time of the carotid artery was 72 min.
By inducing hypothermia, the jugular bulb venous oxygen saturation was raised by 2% on average (n=10). On the other hand, the CO did not change (n=7). The diameter of the internal carotid bulb was increased by 31% compared with that in primary closure. We did not encounter any cerebral ischemic events during the perioperative period. Postoperative follow-up has been continued for 20 months on average, and no restenosis of the internal carotid artery has been experienced in the patients. CEA with a patch graft under mild hypothermia was effective for reducing the occurrence of restenosis and the risk of cerebral ischemia.
