Endoluminal femoropopliteal bypass for intermittent claudication.
OBJECTIVE
(i) to describe our initial clinical experience with endoluminal femoropopliteal bypass using a technique developed in a cadaveric model; (ii) to identify areas requiring technical modification to improve patency and complication rates.


METHODS
prospective, experimental pilot study.


METHODS
fourteen consecutive patients with disabling intermittent claudication and superficial femoral artery occlusion underwent endarterectomy through a groin incision and endoluminal placement of a polytetrafluoroethylene graft. Follow-up was by duplex ultrasound and arteriography.


RESULTS
two endovascular technical failures required conversion to open surgery. The cumulative primary (1 degrees), 1 degrees-assisted and secondary (2 degrees) patency rates at 1 year were 35.7%, 42.8% and 71.4% respectively; at 2 years the patency rates were 14.3%, 31.2% and 57.1%. Twenty-three endovascular interventions were required to maintain graft patency in 10 patients. Five patients subsequently required conventional bypass, of whom two proceeded to major amputation because of graft infection. Seven endovascular grafts remain patent at a mean follow-up of 50 months.


CONCLUSIONS
this minimally invasive surgical technique is feasible, with acceptable patency rates. However, considerable investment of time and resources is required to maintain graft patency. With increasing experience and improved technical design, this procedure may offer a real alternative to conventional surgery in patients disabled by short-distance claudication.
Tisi
P V
PV
Department of Vascular Surgery, Southampton General Hospital, Southampton, U.K.
Cowan
A R
AR
Morris
G E
GE
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015901:Angiography, Digital Subtraction; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004691:Endarterectomy; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000601:surgery*; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation; D018616:Ultrasonography, Doppler, Duplex
D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene