Semiclosed endarterectomy for long superficial femoral artery atherosclerotic occlusive disease - One-year angiographic results

Background The anatomic results of endarterectomy of long occlusive lesions in the superficial femoral artery (SFA) are required for reconsidering thi s procedure and comparing the results with those of newly developed endovas cular techniques. We designed a prospective study to determine the arteriog raphic findings one year after a successful semiclosed endarterectomy of lo ng occlusive lesions Ln the SFA, Methods. From January 1995 until July 1996, an endarterectomy in the SEA wa s attempted in 12 successive patients and was successfully performed in 10 patients (6 men and 4 women), with an average age of 73 years (range 66 to 90 years), Indications for successfully performed procedures mere claudicat ion in 6, non healing ulcer in 2, local gangrene in 2 patients. The mean le ngth of the occlusion was 17 cm (12-33). Six patients had poor run-off with 0 to 1 patent tibial artery. The mean length of the endarterectomised segm ent was 31 cm (27-39), tin, angioscopy and an angiography were performed in all procedures. There were no postoperative complications. All patients ha d an angiography at 12 months or before because of ipsilateral disease. Pri mary angiographic patency was defined as patency of the treated artery with stenosis of less than 30%, A short stenosis was defined as <5 cm, These le sions were an indication of percutaneous balloon angioplasty (PTA) and the final results were listed as secondary patency, Results. Angiography revealed 3 patent arteries, 5 short stenosis, 2 long s tenosis and no occlusions, The primary patency rate was 30% at 12 months. T he secondary patency was 80% with a mean follow-up of 19 months (ranging fr om 13 to 25 months), The mortality and amputation rate at 12 months was nil , Conclusions. Despite a modern intraoperative control, there was a high inci dence of restenosis after semiclosed endarterectomy performed for long occl usive lesions of the SFA, As a result of a close surveillance and PTA, the secondary patency at one year was good. Before a widespread use of newly de veloped endovascular techniques, comparative patency studies with the mere endarterectomy should be performed. Endarterectomy followed by a PTA in cas es of restenosis, is an alternative to bypass when the vein is not availabl e.