Use of a balloon-expandable, radially reinforced ePTFE endograft after remote SFA endarterectomy: a single-center experience.
OBJECTIVE
To report our experience with endovascular femoropopliteal bypass grafting using a distensible, radially reinforced polytetrafluoroethylene endograft combined with remote endarterectomy.


METHODS
Forty-one patients (33 men; mean age 70 years, range 45-79) with symptomatic femoropopliteal occlusive disease underwent remote endarterectomy of the superficial femoral artery (SFA) followed by implantation of a balloon-expandable Enduring endovascular graft. All patients entered an extensive surveillance program, including angiography and duplex scanning at regular intervals.


RESULTS
Endarterectomy and endograft implantation were ultimately successful in all patients; 5 (12%) technical difficulties occurred intraoperatively and were treated with additional endovascular techniques. Control angiography at 1 week postoperatively demonstrated a patent endograft in 39 (95%) patients. Mean ankle-brachial index increased significantly from 0.57 to 0.91 (p < 0.001). Including the 2 early failures, 18 occlusions were documented over a median 15-month follow-up (range 3-24), due mainly to significant stenosis at the proximal and distal anastomoses. In 8 of 10 successfully reopened and revised endografts, reocclusion occurred after a median interval of only 1.8 months. Life-table analysis revealed cumulative primary and secondary patency rates of 42% and 56%, respectively, at 18 months. In the last 12 cases, the proximal end of the graft was sutured end-to-end to the transected SFA, which improved the short-term secondary patency rate to 83%.


CONCLUSIONS
Insertion of the Enduring endovascular graft following remote endarterectomy effectively results in a less invasive treatment for femoropopliteal occlusive disease. Additional technical refinements of the procedure may be required to avoid early procedure- and graft-related failures.
Heijmen
R H
RH
Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. rheijmen@hetnet.nl
Teijink
J A
JA
van den Berg
J C
JC
Overtoom
T T
TT
Pasterkamp
G
G
Moll
F L
FL
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D004691:Endarterectomy; D005121:Extremities / Q000098:blood supply; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures
D011138:Polytetrafluoroethylene