Remote results of eversion carotid endarterectomy depending on the suture material used

Beloyartsev D.F., Talybly O.L.

Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health Russian Medical Academy of Postgraduate Education under the RF Ministry of Public Health, Moscow, Russia

Background. It is known that namely long-term presence of suture material as the only foreign body in autologous conditions may lead to restenosis in the remote period. Such hypothesis was put forward based on good results of reconstructive cardiovascular operations in case of using absorbable suture material.

Objective. Our study was aimed at comparative analysis of remote results of using absorbable suture material polydioxanone and non-absorbable suture material polypropylene in eversion carotid endarterectomy.

Patients and methods. Over the period from 2002 to 2007, at the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky performed a total of 408 carotid reconstructions according to the eversion technique. The study was based on comparative analysis of the remote results of this procedure in two groups of patients: the first group consisted of 121 patients in whom replantation of the internal carotid artery into the common carotid artery was performed using absorbable suture material polydioxanone with the metric sizes 5-0 and 6-0 and the second group comprising 135 patients in whom similar manipulations were performed using non-absorbable suture material polypropylene with the metric size 6-0. In the course of the study it turned out that the remote results might also be influenced by the metric size of polydioxanone, therefore the first group was further subdivided into subgroups: polydioxanone 5-0 – 79 patients and polydioxanone 6-0 – 42 patients.

Results. At baseline, with statistically significant differences by the gender, incidence of unstable atherosclerotic plaque, diameter of the ipsilateral internal carotid artery ≤4 mm, the groups of patients turned out to be in the remote period statistically significantly comparable by such parameters as frequency of the development of a pseudoaneurysm, restenosis of the internal carotid artery, ipsilateral stroke, restenosis-associated stroke, and by survival. However, when comparing the subgroup of patients wherein polydioxanone 6-0 was used and the second group with the initially statistically significant differences by incidence of unstable atherosclerotic plaque and myocardial infarction, in the remote period there was a statistically significant decrease in the incidence rate of restenosis of the internal carotid artery in the first case.

Conclusions. The obtained findings suggested that the absorbable suture material polydioxanone with the metric size 6-0 might be considered as quite a substantiated alternative to the used in cardiovascular surgery non-absorbable suture material polypropylene. Polydioxanone with the metric size 6-0 made it possible to remove or considerably decrease the incidence rate of the development of restenosis of the internal carotid artery after eversion carotid endarterectomy.

KEY WORDS: eversion carotid endarterectomy, restenosis, absorbable suture material.

P. 130-137

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