ABSTRACT
This patient was presented to me by our neurology service fully heparinized with crescendo TIAs and recurrent stenosis, two years after repair elsewhere with a saphenous vein roof patch. In (A), the lateral angiogram showed tight stenosis in the distal ICA. I approached the case with caution, concerned that we would encounter a thin, friable vessel wall with a high likelihood of premature bleeding. The clinical situation was quite different than I had anticipated. (B) shows that the vein patch had actually completely endothelialized and was firm, thick, and easily dissected. The only real way we could tell which was vein and which was native vessel was from the old Prolene suture line. We performed a routine endarterectomy, taking care of course to remove all the old suture fragments, and then placed a Hemashield roof patch (C), after which the patient had a routine and uncomplicated postoperative course.
