patchangioplastie

Patch angioplasty is a vascular surgical technique in which an arteriotomy is closed with aPatch of material to widen and reinforce the arterial lumen after plaque removal or segment repair. It is commonly employed during carotid endarterectomy, femoral endarterectomy, or reconstruction of other diseased arteries, with the aim of reducing restenosis and improving long-term patency.

Indications include repair of arterial wall defects after plaque removal, prevention of narrowing at the arteriotomy site, and restoration of a durable lumen in peripheral or central arteries. The choice of patch material depends on factors such as infection risk, tissue availability, and surgeon preference.

Materials used for patches vary and include autologous vein patches (most often the greater saphenous vein), bovine or porcine pericardial patches, and synthetic materials such as Dacron (polyethylene terephthalate) or PTFE. Autologous patches are favored in infected fields due to lower infection risk, while synthetic patches offer excellent availability and consistency.

Techniques involve tailoring the patch to fit the arteriotomy and suturing it to the artery with fine monofilament sutures, ensuring a tension-free, hemostatic closure. Proper orientation and avoidance of kinking are important to maintain patency.

Outcomes associated with patch angioplasty generally show reduced rates of restenosis and pseudoaneurysm formation compared with primary closure in select procedures, particularly carotid endarterectomy. Risks include infection, patch-related rupture or aneurysm, thrombosis, and bleeding. Postoperative care typically includes antiplatelet therapy and imaging surveillance to assess patency.