Endarterectomy for femoro-popliteal atherosclerosis

303 limbs in 270 patients were operated by endarterectomy for femoro-popliteal atherosclerosis from January 1967 to April 1975. 236 reconstructions were carried out as semi-closed endarterectomy. Sixty-seven open endarterectomies were performed during the same period. In the 2 groups 37% and 33% respectively of the patients were treated for rest-pain and distal gangrene. The remaining patients had intermittent claudication as the main symptom. The operative mortality of the two groups were 2.5% and 4.5% respectively. Although the early results were encouraging, the long-term patency following semi-closed endarterectomy was significantly lower than after saphenous vein by-pass. Open endarterectomies had the same 5-year patency as vein by-pass grafts. This may at least partly be due to case selection, since open endarterectomy was mainly used for short obstructions in limbs with good run-off. Even if fair results may be obtained when semi-closed endarterectomy is performed between 2 arteriotomies above the knee in limbs with good run off, we recommend this method only to be used in cases with insufficient vein for by-pass grafting and sometimes for the treatment of short obstructions of the superficial femoral artery. Since the choice of operative method often has to be done during operation, familiarity with both methods is necessary.