Hemodynamic effects of primary closure versus patch angioplasty of the carotid artery

Abstract

This study evaluated the hemodynamic changes associated with patch angioplasty compared to primary closure of the canine carotid artery. A standard arteriotomy was closed either primarily, with a 5x28 mm expanded polytetrafluoroethylene (ePTFE) patch, or with a 10x28 mm ePTFE patch. Measurements for the primary closure group showed a systolic pressure gradient of 17 mmHg across the closure and a peak systolic velocity increase of 58% at mid-closure compared to proximal inflows. Flow turbulence increased at mid-closure in the 10 mm patch group, with the percent spectral window lowered from 0.50 to 0.36. These data show that primary vessel closure creates a mild local stenosis with flow acceleration but no flow turbulence. No significant hemodynamic disturbances are caused by a moderate sized patch; however, a large patch relative to native vessel dimensions creates marked flow disturbances throughout the cardiac cycle. As turbulence and flow separation are felt to contribute to restenosis, care should be taken in the selection of patch size when used following carotid endarterectomy.