Ipsilateral carotid bypass outcomes in hostile neck anatomy

Andres Guerra, Ashish K. Jain, Mark K. Eskandari, Heron E. Rodriguez*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine differences in outcomes among patients undergoing ipsilateral carotid bypass with hostile or normal neck anatomy. Methods: Single-center retrospective review of all ipsilateral extracranial carotid bypasses performed between 1998 and 2018. Results: Forty-eight patients underwent ipsilateral carotid bypass from the common carotid artery to either the internal carotid artery or carotid bifurcation during the study period. Seven patients were excluded owing to either a lack of follow-up or missing data. The indications for intervention included infected patches, aneurysmal degeneration, symptomatic and asymptomatic stenosis or restenosis, carotid body tumors, neck malignancy, and trauma. In 25 procedures (61%), there was a hostile neck anatomy defined as a prior history of external beam neck irradiation or neck surgery. Among this group, 12 pectoralis muscle flaps were performed for reconstructive coverage. Conduits included polytetrafluorethylene (n = 21), great saphenous vein (n = 9), superficial femoral artery (n = 7) and arterial homograft (n = 4). All superficial femoral artery conduits were used in the hostile neck group (P = .03). The overall mean time of follow-up was 22 months, with all bypasses remaining patent with no significant clinical stenosis. The 30-day ipsilateral stroke and myocardial infarction rates were 4.88% each, all within the hostile neck group, with no 30-day mortalities for the entire cohort. One-third of the muscle flaps were performed in the setting of infected patches (P = .02) with no significant differences in perioperative outcomes with use. The overall median hospital length of stay was significantly increased in patients receiving muscle flap coverage (3.0 vs 7.0 days; P = .04). Conclusions: In patients with a complex carotid pathology, ipsilateral carotid bypass is an effective solution for carotid reconstruction. Different conduits should be used depending on the indication. Muscle flap coverage should be considered in hostile settings when primary wound closure is not feasible.

Original languageEnglish (US)
Pages (from-to)1929-1936
Number of pages8
JournalJournal of Vascular Surgery
Volume74
Issue number6
DOIs
StatePublished - Dec 2021

Keywords

  • Carotid artery diseases
  • Surgical flaps
  • Vascular grafting
  • Vascular patency

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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