Endovascular femoropopliteal bypass combined with remote endarterectomy inSFA occlusive disease: Initial experience

Objectives: to evaluate the feasibility of endovascular femoropopliteal byp ass in combination with remote endarterectomy of the superficial femoral ar tery (SFA). Design: prospective, open study. Materials: thirteen patients with chronic lower-leg ischaemia due to femoro popliteal occlusive disease underwent 14 SFA remote endarterectomy procedur es followed by endovascular ePTFE femoropopliteal bypass. Primary endograft ing was performed in seven cases. the indication for endograft insertion wa s vessel-wall perforation during endarterectomy in the remaining seven case s. Methods: pre- and postoperative clinicl and haemodynamic data were collecte d and compared. Technical problems and procedure-related complications were noted. Results: initial technical success was achieves in all 14 limbs. However, f our early reocclusions occurred after 1, 4, 6 and 10 weeks postoperatively. Two late reocclusions were detected after 16 and 22 months without and pre ceding symptoms or haemodynamic changes. Primary and secondary patency rate s were 61% and 70% at two years, probably due to graft-related factors, suc h as lack of radial force, graft folding or kinking, and possibly altered m echanical or thrombogenetic properties after dilation of the ePTFE graft. Conclusions: endovascular femoropopliteal endo-bypass after SFA remote enda rterectomy is a feasible procedure. further technical improvements are nece ssary to avoid procedure- and graft-related early failures.