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Background: Bypass for extra-cranial arterial disease is infrequently carried out. We reviewed our experience to determine the outcome of carotid artery grafting using either an autogenous vein or polytetrafluoroethylene (PTFE). Methods: Details of patients were recorded prospectively as part of a vascular surgical registry. Patients identified from the registry as having carotid artery bypass procedures were classified according to the type of conduit used. Comparison was made between patients with autogenous vein and PTFE grafts. Results: Between 1978 and 2002, 24 patients (13 men and 11 women) mean age 60.0 ± 13.4 years (range, 20–81 years) underwent 28 bypass procedures (three were bilateral and one was a reoperation). Symptomatic carotid disease was the clinical indication in 20 of 28 procedures (71.4%). Pathological indications included advanced atherosclerosis of the carotid arteries (15), past radiotherapy (4), failed stenting (3), resection of carotid body tumour (2), trauma (1), reoperation on a failed graft (1), carotid aneurysm (1) and iatrogenic carotid occlusion (1). An autogenous vein was used in 16, PTFE in 11 and autogenous artery in 1 of the patients. Using the Kaplan–Meier method, the overall patient cumulative 5-year survival was 84% and cumulative 5-year stroke-free survival was 93%. The combined perioperative stroke and mortality rate was 7.1%. Two patients had transient ischaemic attacks (7.1%), one had cranial nerve palsies (3.6%) and one required reoperation for bleeding (3.6%). Five-year cumulative graft primary patency using the Kaplan–Meier method was 74% for PTFE grafts and 92% for autogenous vein grafts (P = 0.37). Conclusion: Carotid artery bypass is a safe and a useful treatment option for complex extra-cranial arterial disease. Either PTFE or autogenous veins may be used as conduits.

Vascular surgeons were involved in the early development of the vascular laboratory in Australia, extrapolating experience gained overseas, introducing the methodology and training programmes and later determining qualifications and standards. Common themes emerged in a review of individual surgeons' involvement, notably their early commitment, ingenuity in overcoming financial and political barriers and the close working relationship that developed between them and their vascular technologists. Vascular surgeons are now a minority player in vascular imaging but retain important leadership roles. If the next generation of vascular surgeons is to retain their involvement in the vascular laboratory, there are inherent capital costs they need to meet and administrative skills necessary to complement clinical expertise to deliver optimum vascular surgical care. Just as endovascular skills are now being introduced into the traditional armamentarium, experience in the vascular laboratory must be consolidated in vascular fellowship training -programs. This has implications for manpower, resources and training.

Background: Because a large percentage of patients surviving carotid endarterectomy (CEA) subsequently die from a vascular cause, the aim of the present paper was to determine risk factor management for a cohort of patients 4 years after their CEA. Methods: Surviving patients who had a CEA within the region administered by the Central Sydney Area Health Service in 1995 were asked to complete a self-administered questionnaire to determine vascular risk factors. Results: Of the 181 patients eligible to participate, 162 returned questionnaires (response rate: 90%). While 106 (65.4%) patients recalled that they had been diagnosed with high blood pressure either before or after their CEA, only 79.2% recalled that their latest blood pressure reading was ‘about right for my age’. Nearly one in five (16.7%) who had had their cholesterol level checked in the last 12 months (n = 120) indicated that the reading was ‘too high’. Only 76.5% reported taking medications to ‘thin the blood’. Almost one-fifth of patients (17.3%) were current smokers. Only 35.2% of patients participated in a level of physical activity sufficient to confer a health benefit. Further, 30.2% of patients were overweight and 14.8% were obese. The majority of patients (98.1%) reported having a regular general practitioner (GP). Of these, 98.7% had visited their GP at least once within the previous 6 months. Conclusions: Vascular risk factor management following CEA is suboptimal, inviting the implementation and evaluation of strategies to improve outcomes.

Maggi Boult, Wendy Babidge, John Anderson, Michael Denton, Robert Fitridge, John Harris, Michael Lawrence-Brown, James May, Kenneth Myers and Guy Maddern

Two patients with occlusion of the internal carotid artery who were experiencing repeated episodes of transient monocular blindness in the ipsilateral eye were successfully treated with external carotid endarterectomy. The mechanisms for the production of symptoms in the presence of an internal carotid occlusion are discussed, including the anatomical pathways for embolization through collaterals between the internal and external carotid arteries. The indications, technique and results of external carotid endarterectomy are reviewed.