ABSTRACT
There are two main causes of recurrent stenosis, aside from technical error. These are myointimal hyperplasia, which is usually rapid in onset, and recurrent atheromatous disease, which takes longer to develop. In the case illustrated here, a 45-year-old man with familial hyperlipidemia was operated by me with an 80% asymptomatic stenosis without a patch graft (this is an older case of mine). He returned six months later with routine duplex scans that showed a rapid recurrence (90% stenosis), and he chose to be re-operated with a roof patch (in this case a saphenous vein patch) as I recommended to him. At surgery we found a thickened fibrotic vessel wall with no real evidence of atheroma. A plane was developed with some difficulty and an uneventful patch graft repair was performed, after which he did well in long-term follow-up, with no late evidence of recurrence.
