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. 2025 Apr 30;33(2):133-143.
doi: 10.5606/tgkdc.dergisi.2025.27226. eCollection 2025 Apr.

Evaluation of mid- and long-term outcomes following carotid endarterectomy with a double-layer primary arteriotomy closure technique

Hüseyin Ali Tünel  1 , İzzet Hafez  1 , Adem İlkay Diken  1 , Muhammed Onur Hanedan  2
Affiliations

Evaluation of mid- and long-term outcomes following carotid endarterectomy with a double-layer primary arteriotomy closure technique

Hüseyin Ali Tünel et al. Turk Gogus Kalp Damar Cerrahisi Derg. .

Abstract

Background: This study aims to evaluate the mid- and long-term outcomes of patients who underwent carotid endarterectomy with double-layer primary arteriotomy closure technique.

Methods: Between January 2011 and January 2021, a total of 94 patients (58 males, 36 females; mean age: 66.5±8.5 years; range, 40 to 82 years) who underwent carotid endarterectomy were retrospectively analyzed. Doppler ultrasonography, computed tomography or magnetic resonance angiography, and digital subtraction angiography were utilized during follow-up. Stenoses of 50% and above were defined as restenosis.

Results: The mean carotid clamp time was 11.72±2.30 and the mean follow-up was 54.18±27.71 months. Two patients (2.1%) underwent revision due to bleeding and hematoma. No new cerebrovascular events were observed in the postoperative period (<30 days). During the follow-up, six (6.4%) patients with ≥50% stenosis on the same side and 14 (14.9%) patients with stenosis on the opposite side were identified. Primary patency rates were found to be 99% at one year, 95.4% at three years, 90% at five years, 71% at seven years, and 71% at nine years. Age was the only independent risk factor affecting survival.

Conclusion: Our study results suggest that this technique can be used safely in patients with appropriate internal carotid artery diameter with favorable mid- and long-term patency rates.

Keywords: Carotid endarterectomy; patch closure; primary closure..

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Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1
Figure 1. (a) Following the removal of atherosclerotic tissues, the media and adventitia layers identified. (b) The media layer of the artery is sutured with a continuous technique using 6/0 polypropylene suture. (c) The vascular clamps removed from CCA, ECA, and ICA. The closure was finalized by suturing the preserved adventitial layer as the second layer with a continuous suture technique using the same suture. CCA: Common carotid artery; ECA: External carotid artery; ICA: Internal carotid artery.
Figure 2
Figure 2. Primary patency during the follow-up period.
Figure 3
Figure 3. Survival curve during the follow-up period.
See this image and copyright information in PMC

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