Remote superficial femoral artery endarterectomy: Multicenter medium-term results

Objective: The results of percutaneous transluminal angioplasty, atherectom y, and laser angioplasty for the treatment of long-segment (>10 cm) superfi cial femoral artery (SFA) occlusive disease have proved disappointing. Remo te superficial femoral artery endarterectomy (RSFAE) is a minimally invasiv e procedure, performed through a single limited groin incision that may off er patency rates comparable with those of above-knee femoropopliteal (AKFP) bypass graft. In this retrospective multicenter study the medium-term resu lts of RSFAE are examined. Methods: Sixty patients were included in this study. Indications for the pr ocedure were claudication in 52 patients and limb salvage in eight patients . RSFAE was performed with the MollRing Cutter device through a femoral art eriotomy. The distal "flap" of atheroma was anchored by balloon/stent angio plasty through the femoral axteriotomy. Ail patients underwent a follow-up examination with serial color flow ultrasound scanning. Results: Ten patients with heavily calcified SFAs failed as "intentions to treat"; these patients underwent AKFP bypass grafting. The mean length of t he endarterectomized SFAs was 22.3 cm (range, 8-37 cm). The primary cumulat ive patency rate by means of life-table analysis was 61.4%+/-9% (SE), (mean , 12.9 months; range, 3-36 months). During follow-up, percutaneous translum inal angioplasty was necessary in 14 patients, for a primary-assisted paten cy rate of 82.6%+/-8%. The locations of the restenoses after RSFAE were eve nly distributed along the endarterectomized SFAs. There were no deaths and one wound complication (hematoma), and the mean hospital length of stay was 1.4 days +/- 0.8 days. Conclusions: RSFAE is a safe and moderately durable procedure. If long-term patency rates are similar to those of AKFP bypass graft, RSFAE may prove t o be a minimally invasive adjunct for the treatment of SFA occlusive diseas e that will lower operative morbidity, reduce hospital LOS, and shorten rec uperation.