Use of a balloon-expandable, radially reinforced ePTFE endograft after remote SFA endarterectomy: A single-center experience

Purpose: To report our experience with endovascular femoropopliteal bypass grafting using a distensible, radially reinforced polytetrafluoroethylene e ndograft combined with remote endarterectomy. Methods: Forty-one patients (33 men; mean age 70 years, range 45-79) with s ymptomatic femoropopliteal occlusive disease underwent remote endarterectom y of the superficial femoral artery (SFA) followed by implantation of a bal loon-expandable Enduring endovascular graft. All patients entered an extens ive surveillance program, including angiography and duplex scanning at regu lar intervals. Results: Endarterectomy and endograft implantation were ultimately successf ul in all patients; 5 (12%) technical difficulties occurred intraoperativel y and were treated with additional endovascular techniques. Control angiogr aphy at 1 week postoperatively demonstrated a patent endograft in 39 (95%) patients. Mean ankle-brachial index increased significantly from 0.57 to 0. 91 (p<0.001). Including the 2 early failures, 18 occlusions were documented over a median 15-month follow-up (range 3-24), due mainly to significant s tenosis at the proximal and distal anastomoses. In 8 of 10 successfully reo pened and revised endografts, reocclusion occurred after a median interval of only 1.8 months. Life-table analysis revealed cumulative primary and sec ondary patency rates of 42% and 56%, respectively, at 18 months. In the las t 12 cases, the proximal end of the graft was sutured end-to-end to the tra nsected SFA which improved the short-term secondary patency rate to 83%. Conclusions: Insertion of the Enduring endovascular graft following remote endarterectomy effectively results in a less invasive treatment for femorop opliteal occlusive disease. Additional technical refinements of the procedu re may be required to avoid early procedure- and graft-related failures.