[Endarterectomy using a Simpson catheter in arterial insufficiency of the lower limbs]

Treatment of arterial stenoses by the Simpson atherectomy catheter is carried out by resecting the atheroma. A rotating cutter housed in a cylindrical chamber with a lateral opening is applied against the arterial wall by a low-pressure balloon. Several cuts are made until a large enough diameter of arterial lumen is obtained. We report the results in the first 6 patients treated by this technique using 7F and 9F catheters. All had short (less than 2 cm) and narrow (greater than or equal to 70%) stenoses of iliac, superficial femoral or popliteal arteries. To reduce the stenoses to 30% or less, 4 to 11 cuts were necessary. Histological study of the fragments was performed. The result was inadequate in the only case of stenotic iliac artery and we proceeded with balloon dilatation. The small fragments obtained in this particular case were very hard and calcified. 4 patients with claudication (superficial femoral or popliteal stenosis) were asymptomatic after treatment, whereas one patient suffering from Burger's disease with acral necrotic lesions did not benefit from the procedure in spite of a good morphological result. No complication was encountered. This efficient technique is especially indicated in short segmental stenoses of femoro-popliteal or possibly iliac arteries. It avoids the usual intimal cracks associated with balloon angioplasty and produces a smooth surface whose long term benefit has still to be demonstrated.