Results of endovascular superficial femoral endarterectomy

Background: Endovascular superficial femoral artery (SFA) endarterectomy wi th a ring stripper/cutter and distal stenting has been suggested to have a patency comparable with above-knee bypass surgery. We report our initial ex perience with this technique. Methods: Seventeen patients (13 men and 4 women; mean age, 64 years) with S FA occlusion and above-knee popliteal reconstitution underwent attempted re mote endarterectomy with a ring cutter system combined with primary stentin g of the distal end point. Analysis was performed in a prospective manner w ith patency rates determined by Kaplan-Meier life-table analysis. Results: The indication for operation was claudication in 8 patients, rest pain in 6, and tissue loss in 3. Initial technical success was achieved in 11 patients (65%). Reasons for technical failure included SFA perforation ( 4), inability to traverse a calcified/diseased segment (1), and inability t o retract/remove the ring cutter (1). Life-table analysis of all patients r evealed a primary patency at 1 year of 26% +/- 11%. Primary-assisted patenc y was 38% +/- 12% at 1 year, with 59% of patients ultimately requiring surg ical bypass grafting. In patients in whom initial technical success was ach ieved, the 1-year primary and primary-assisted patency rates were 40% and 5 9%, respectively. There were four reocclusions requiring surgical revascula rization with below-knee popliteal (2) or tibial (2) bypass grafting, 1 sym ptomatic restenosis requiring repeat angioplasty, and 1 symptomatic resteno sis treated conservatively. Conclusion: The results of endovascular SFA endarterectomy were disappointi ng, with technical success in less than two thirds of patients and a 1-year primary patency of only 26%. Remote SFA endarterectomy appears less effect ive than above-knee femoropopliteal bypass grafting, and after early failur e, patients may require more distal revascularization for limb salvage.