title: Results of endovascular superficial femoral endarterectomy.
abstract: BACKGROUND
  Endovascular superficial femoral artery (SFA) endarterectomy with a ring stripper/cutter and distal stenting has been suggested to have a patency comparable with above-knee bypass surgery. We report our initial experience with this technique.
  
  
  METHODS
  Seventeen patients (13 men and 4 women; mean age, 64 years) with SFA occlusion and above-knee popliteal reconstitution underwent attempted remote endarterectomy with a ring cutter system combined with primary stenting of the distal end point. Analysis was performed in a prospective manner with patency rates determined by Kaplan-Meier life-table analysis.
  
  
  RESULTS
  The indication for operation was claudication in 8 patients, rest pain in 6, and tissue loss in 3. Initial technical success was achieved in 11 patients (65%). Reasons for technical failure included SFA perforation (4), inability to traverse a calcified/diseased segment (1), and inability to retract/remove the ring cutter (1). Life-table analysis of all patients revealed a primary patency at 1 year of 26% +/- 11%. Primary-assisted patency was 38% +/- 12% at 1 year, with 59% of patients ultimately requiring surgical bypass grafting. In patients in whom initial technical success was achieved, the 1-year primary and primary-assisted patency rates were 40% and 59%, respectively. There were four reocclusions requiring surgical revascularization with below-knee popliteal (2) or tibial (2) bypass grafting, 1 symptomatic restenosis requiring repeat angioplasty, and 1 symptomatic restenosis treated conservatively.
  
  
  CONCLUSIONS
  The results of endovascular SFA endarterectomy were disappointing, with technical success in less than two thirds of patients and a 1-year primary patency of only 26%. Remote SFA endarterectomy appears less effective than above-knee femoropopliteal bypass grafting, and after early failure, patients may require more distal revascularization for limb salvage.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: P R
authors.initials: PR
authors.lastname: Nelson
authors.forename: R J
authors.initials: RJ
authors.lastname: Powell
authors.forename: R R
authors.initials: RR
authors.lastname: Proia
authors.forename: M L
authors.initials: ML
authors.lastname: Schermerhorn
authors.forename: M F
authors.initials: MF
authors.lastname: Fillinger
authors.forename: R M
authors.initials: RM
authors.lastname: Zwolak
authors.forename: D B
authors.initials: DB
authors.lastname: Walsh
authors.forename: J L
authors.initials: JL
authors.lastname: Cronenwett
mesh_terms: D017130:Angioplasty; D001161:Arteriosclerosis / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014654:Vascular Patency