Endovascular femoropopliteal bypass combined with remote endarterectomy in SFA occlusive disease: initial experience

Objectives: to evaluate the feasibility of endovascular femoropopliteal bypass in combination with remote endarterectomy of the superficial femoral artery (SFA).

Design: prospective, open study.

Materials: thirteen patients with chronic lower-leg ischaemia due to femoropopliteal occlusive disease underwent 14 SFA remote endarterectomy procedures followed by endovascular ePTFE femoropopliteal bypass. Primary endografting was performed in seven cases. The indication for endograft insertion was vessel-wall perforation during endarterectomy in the remaining seven cases.

Methods: pre- and postoperative clinicl and haemodynamic data were collected and compared. Technical problems and procedure-related complications were noted.

Results: initial technical success was achieved in all 14 limbs. However, four early reocclusions occurred after 1, 4, 6 and 10 weeks postoperatively. Two late reocclusions were detected after 16 and 22 months without any preceding symptoms or haemodynamic changes. Primary and secondary patency rates were 61% and 70% at two years, probably due to graft-related factors, such as lack of radial force, graft folding or kinking, and possibly altered mechanical or thrombogenetic properties after dilatation of the ePTFE graft.

Conclusions: endovascular femoropopliteal endo-bypass after SFA remote endarterectomy is a feasible procedure. Further technical improvements are necessary to avoid procedure- and graft-related early failures.