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Semi-closed femoropopliteal thromboendarterectomy: a prospective study
P Heider1, M Hofmann, P C Maurer
1Department of Vascular Surgery, Klinikum rechts der Isar, Munich, Germany.
Insights
This study found that angioscopically controlled thromboendarterectomies of the superficial femoral artery have a lower five-year patency rate compared to bypass grafting. These findings suggest thromboendarterectomy is not a standard procedure for femoropopliteal revascularization.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Superficial femoral artery (SFA) occlusive disease is a common cause of critical limb ischemia.
- Thromboendarterectomy and bypass grafting are surgical options for SFA revascularization.
- Angioscopic control aims to improve outcomes in endarterectomy procedures.
Purpose of the Study:
- To evaluate the primary patency rates of angioscopically controlled thromboendarterectomies of the superficial femoral artery.
- To compare the long-term efficacy of this technique with existing revascularization methods.
Main Methods:
- A prospective open study was conducted from 1990 to 1995.
- Femoropopliteal thromboendarterectomies were performed in 63 patients.
- Follow-up included non-invasive pressure measurements and IVDSA at 1 year, with a mean follow-up of 57 months.
Main Results:
- 55 patients were eligible for analysis; 8 were not evaluable.
- Postoperative complications occurred in 5.4% of patients.
- The 5-year primary patency rate was 44.5%, with 16.4% late occlusions.
Conclusions:
- Angioscopically controlled thromboendarterectomy demonstrated a lower 5-year patency rate than bypass grafting.
- This technique is not recommended as a standard procedure for femoropopliteal revascularization.
- Findings contrast with previous positive literature reports on similar interventions.
Objective:
to study the primary patency rates of angioscopically controlled thromboendarterectomies of the superficial femoral artery.
Design:
prospective open study.
Methods:
between 1990 and 1995, femoropopliteal thromboendarterectomies were performed in 63 patients (41 male, 22 female). Postoperative follow up was performed at 3- to 6-month intervals using non-invasive pressure measurements plus IVDSA at 1 year.
Results:
eight patients were not evaluable, leaving 55 patients eligible for follow-up analysis. Postoperative complications (arteriovenous fistulas, false aneurysms) were observed in 5.4% of patients. Immediate perioperative occlusions occurred in 7.3%, early occlusions in 21.8% and late occlusions in 16.4% of all cases. The mean follow-up was approximately 57 months. The mean primary patency rate at 5 years was 44.5% (28 patients with the superficial femoral artery still open). Six patients died during the follow-up period.
Conclusions:
in contrast to the very positive reports found in recent literature, this prospective study shows a lower five-year patency rate for semi-closed femoropopliteal thromboendarterectomy than for bypass grafting. Thromboendarterectomy cannot be considered as a standard procedure in revascularisation of the femoropopliteal region.