Endoluminal femoropopliteal bypass for intermittent claudication

Objectives: (i) to describe our initial clinical experience with endolumina l femoropopliteal bypass using a technique developed in a cadaveric model; (ii) to identify areas requiring technical modification to improve patency and complication rates. Design: prospective, experimental pilot study. Materials and methods: fourteen consecutive patients with disabling intermi ttent claudication and superficial femoral artery occlusion underwent endar terectomy through a groin incision and endoluminal placement of a polytetra fluoroethylene graft. Follow-up was by duplex ultrasound and arteriography. Results: two endovascular technical failures required conversion to open su rgery. The cumulative primary (1 degrees), 1 degrees-assisted and secondary (2 degrees) patency rates at 1 year were 35.7%, 42.8% and 71.4% respective ly; at 2 years the patency rates were 14.3%, 31.2% and 57.1%. Twenty-three endovascular interventions were required to maintain graft patency in 10 pa tients. Five patients subsequently required conventional bypass, of whom tw o proceeded to major amputation because of graft infection. Seven endovascu lar grafts remain patent at a mean follow-up of 50 months. Conclusions: this minimally invasive surgical technique is feasible, with a cceptable patency rates. However, considerable invest ment of time and reso urces is required to maintain graft patency. With increasing experience and improved technical design, this procedure may offer a veal alternative to conventional surgery in patients disabled by short-distance claudication.