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. 2013;8(1):e55050.
doi: 10.1371/journal.pone.0055050. Epub 2013 Jan 31.

Systematic review of randomized controlled trials of different types of patch materials during carotid endarterectomy

Shiyan Ren  1 , Xianlun Li, Jianyan Wen, Wenjian Zhang, Peng Liu
Affiliations

Systematic review of randomized controlled trials of different types of patch materials during carotid endarterectomy

Shiyan Ren et al. PLoS One. 2013.

Abstract

Background and purpose: Carotid endarterectomy (CEA) with patch angioplasty produces greater results than with primary closure; however, there remains uncertainty on the optimal patch material in CEA. A systematic review of randomized controlled trials (RCTs) was performed to evaluate the effect of angioplasty using venous patch versus synthetic patch material, and Dacron patch versus polytetrafluoroethelene (PTFE) patch material during CEA.

Methods: A multiple electronic health database screening was performed including the Cochrane library, Pubmed, Ovid, EMBASE and Google Scholar on all randomized controlled trials (RCTs) published before November 2012 that compared the outcomes of patients undergoing CEA with venous patch versus synthetic patch. RCTs were included if they compared carotid patch angioplasty with autologus venous patch versus synthetic patch material, or compared one type of synthetic patch with another.

Results: Thirteen RCTs were identified. Ten trials, involving 1946 CEAs, compared venous patch with synthetic patch materials. Two trials, involving 400 CEAs in 380 patients, compared Dacron patch with PTFE patch. The hemostasis time in CEA with PTFE patch was significantly longer than with venous patch (P<0.0001), and longer than with Dacron patch (P<0.0001). There was no significant difference of mortality rate, stroke rate, restenosis, and operative time in CEA with venous patch versus synthetic patch material, or in CEA with Dacron patch versus PTFE patch (all P>0.05). One RCT of 95 CEAs in 92 patients compared bovine pericardium with Dacron patch, and demonstrated a statistically significant decrease in intraoperative suture line bleeding with bovine pericardium compared with Dacron patch (P<0.001).

Conclusions: The hemostasis time in CEA with PTFE patch was longer than with venous patch or Dacron patch. The overall perioperative and long-term mortality rate, stroke rate, restenosis, and operative time were similar when using venous patch versus synthetic patch material or Dacron patch versus PTFE patch material during CEA. More data are required to clarify differences between different patch materials.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram showing different steps of the systematic review.
RCTs: randomized controlled trials.
Figure 2
Figure 2. Mortality in both groups.
Graphical representation of the results. M-H : Mantel-Haenszel.
Figure 3
Figure 3. Any stroke event is compared in both groups.
Graphical representation of the results. M-H: Mantel-Haenszel.
Figure 4
Figure 4. Restenosis of carotid artery in both groups.
Graphical representation of the results. M-H: Mantel-Haenszel.
Figure 5
Figure 5. Postoperative wound infection events in both groups.
Graphical representation of the results. M-H : Mantel-Haenszel.
Figure 6
Figure 6. Reoperation for wound hematoma compared in both groups.
Graphical representation of the results. M-H: Mantel-Haenszel.
Figure 7
Figure 7. Mean operative time (a) and mean hemostasis time (b) in minutes are compared in both groups.
Graphical representation of the results.
Figure 8
Figure 8. Meta-analysis of incidence of mortality rate (a), TIA and stroke (b), 50% restenosis to occlusion of carotid artery (c), and carotid thrombosis (d) after carotid endarterectomy, comparing Dacron and PTFE during CEA in randomized controlled trials.
CEA carotid endarterectomy; M-H Mantel-Haenszel; PTFE polytetrafluoroethelene.
Figure 9
Figure 9. Meta-analysis of hemostasis time (a), and operative time (b) in minutes during carotid endarterectomy, comparing Dacron and PTFE during CEA in two randomized controlled trials.
CEA: carotid endarterectomy; PTFE: polytetrafluoroethelene.
See this image and copyright information in PMC

References

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