Alternative femoral endarterectomies: technical aspects and short-term results

Femoral endarterectomies are often performed by means of longitudinal arteriotomies with patching. Autologous and synthetic patches can be used. Synthetic patches in the groin may expose patients to infection. We present two alternative techniques for the treatment of femoral atherosclerotic lesions.

The alternative endarterectomies (AE) included eversion (EE) and semi-closed endarterectomies (SCE). An EE with an oblique transection of a femoral bifurcation (FB) was used for lesions extending to the FB. The artery was reconstructed in an end-to-end manner. An SCE with a bovine pericardium patch (BPP) was used for lesions extending further. An arteriotomy was made from the superficial femoral artery just past the level of the profunda femoris opening (PFO). The plaque was cut proximally to the PFO, dissected circularly with a Swedish-type dissector, and then removed with Crile forceps. The distally remaining plaque was endarterectomized in a conventional manner. The arteriotomy was closed with a BPP.

A total of 21 AEs were performed, 8 of which were accomplished in a hybrid setting. There were no periprocedural complications. One distal embolization after a balloon dilatation was registered during the early postoperative period. The median follow-up was 3 months. There were no deep wound infections, pseudoaneurysms, amputations, or deaths. A total of 20/21 patients reported complete symptom relief, with one requiring an additional femoro-popliteal bypass grafting owing to poor outflow. The primary patency rate of the endarterectomized segments was 100%.

Alternative methods of local endarterectomy can extend the available range of procedures for patients suffering from chronic lower-limb ischemia. According to our results, these endarterectomy techniques are safe and could be taken into consideration, as they provide some advantages over conventional methods.