Maintenance of patency following remote superficial femoral artery endarterectomy.
BACKGROUND
Remote superficial femoral artery endarterectomy (RSFE) is a minimally invasive means of superficial femoral artery revascularisation. It comprises a single groin incision and securing of the distal cut end of atheroma with an intraluminal stent.


OBJECTIVE
To determine medium-term results of RSFE, with particular reference to costs of maintaining patency.


METHODS
Stenosis development, and patency of 25 RSFE were compared with 25 randomly selected in situ vein bypasses with similar follow-up (18-33 months).


RESULTS
Following RSFE 17 stenoses were identified by duplex surveillance. Half of those arteries patent at 1 yr had stenoses. Angioplasty (PTA) was carried out for 11 stenoses. Four stenoses developed more than 12 months following RSFE. One patient died and nine arteries occluded during follow-up. Primary and primary- assisted patency at 18 months were 31 and 63% respectively. By contrast six stenoses were identified in 25 in situ grafts, all within one year. Four PTAs were carried out. Three grafts occluded. Excluding cost of three monthly duplex surveillance the cost of maintaining RSFE patency was approximately five times that of maintaining in situ bypass patency.


CONCLUSIONS
The initial cost advantage of RSFE is offset by the increased costs of maintaining patency. Duplex surveillance probably needs to be continued indefinitely.
Galland
R B
RB
Department of Surgery and Radiology, Royal Berkshire Hospital, London Road, Berks, Reading, UK.
Whiteley
M S
MS
Gibson
M
M
Simmons
M J
MJ
Torrie
E P
EP
Magee
T R
TR
D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000601:surgery*; D004691:Endarterectomy / Q000191:economics / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011184:Postoperative Period; D055502:Secondary Prevention; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics; D014654:Vascular Patency