Carotid endarterectomy

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Abstract
The healing of the canine carotid endarterectomy was defined at intervals from 30 min to 3 mo. after surgery by angiography, light microscopy and scanning electron microscopy. Immediately after flow was established, a fibrin-platelet carpet formed on the endarterectomized surface. A typical thrombus formed on this initial layer resulting in vessel occlusion in 52% of non-heparinized animals. By 48 h after surgery, there was little evidence of active thrombus formation, and re-endothelialization from existing endothelial cells was noted. One week later most of the mural thrombus had disappeared and re-endothelialization was well underway. By 3 mo. after surgery, re-endothelialization was complete. Intraoperative heparinization resulted in a striking reduction in mural thrombus formation and 100% patency rate. Vessel closure with vein-patch grafts resulted in no improvement of vessel patency. The results of this aspect of the study cannot be totally extrapolated to human carotid endarterectomy for the reasons discussed. The survival of the vein-patch grafts was investigated.