Incidence, time-of-onset, and anatomical distribution of recurrent stenoses after remote endarterectomy in superficial femoral artery occlusive disease.
OBJECTIVE
The incidence, time-of-onset, and anatomical distribution of recurrent stenoses after remote endarterectomy in superficial femoral artery (SFA) occlusive disease were studied.


METHODS
Patients undergoing SFA remote endarterectomy procedures were examined with duplex surveillance. Patients were examined at 6 weeks, 3, 6, 9, and 12 months, and then annually. Recurrent stenosis was defined as a peak systolic velocity ratio of 2.5 or higher. Duplex results were also compared with clinical and hemodynamic changes.


RESULTS
Restenoses were identified in 46 of 101 (46%) limbs treated after a mean interval of 5.8 months (range, 1 to 18 months). These 46 limbs formed the base of this study. The median follow-up period was 25 months. Thirty-eight (83%) of all restenoses were detected within 1 year. The lesions were located within the entire SFA and were not specifically related to the adductor canal or distal stented region only. Multiple stenoses were found in 21 limbs. Only 10 (22%) restenoses were correlated with worsening of clinical symptoms, change of ankle-brachial index, or both. Ten of 23 cases (43%) of nonrevised restenoses progressed to occlusion. These 10 occlusions occurred in all patients with restenosis that developed within the first year. Nonrevised late restenoses (more than 1 year) were not associated with any reocclusion.


CONCLUSIONS
Recurrent stenoses after SFA remote endarterectomy were noticed in 46 of 101 (46%) limbs. Most restenoses (83%) developed within the first year. In the nonrevised group, time-of-onset restenosis (less than 1 year) was correlated with a higher risk for occlusion ( P =.02). The location of restenoses were found without any anatomical site of preference along the entire endarterectomized SFA segment.
Department of Vascular Surgery, St. Antonius Hospital, and the Julius Centre for Patient Oriented Research, University Hospital Utrecht, The Netherlands.
G H
GH
Ho
P A
PA
van Buren
F L
FL
Moll
J G
JG
van der Bom
B C
BC
Eikelboom
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D012008:Recurrence; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex