title: How to avoid a difficult groin in redo arterial surgery: eversion endarterectomy of the proximal superficial femoral artery versus profunda femoris artery as inflow for distal bypass.
abstract: BACKGROUND
  The aim of the study was to describe and analyze the results of a technique in which the inflow for distal bypasses is provided by the proximal superficial femoral artery, reopened through an eversion endarterectomy, to avoid a "difficult groin."
  
  
  METHODS
  Twenty-one patients who underwent distal bypass for severe lower-limb ischemia and in whom the proximal superficial femoral artery was reopened with an eversion endarterectomy to provide inflow for the bypass itself were included in the study. As a comparison group, 20 patients in whom the inflow for a distal bypass was obtained by the distal deep femoral artery were randomly selected. In all 41 patients, the groin was considered "difficult" because of multiple previous operations.
  
  
  RESULTS
  Five-year cumulative patency rates were 53% for femoropopliteal bypasses and 40% for femorotibial bypasses. Similar patency rates were obtained when the distal deep femoral artery was used as inflow.
  
  
  CONCLUSIONS
  Eversion endarterectomy of the proximal superficial femoral artery provides a valid source of inflow for distal bypasses, and it should be kept in the armamentarium of the vascular surgeon, to be used in selected cases.
authors.affiliation: I Isituto Clinica Chirurgica, Università di Roma La Sapienza, Roma, Italia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cavallaro
authors.forename: Antonio V
authors.initials: AV
authors.lastname: Sterpetti
authors.forename: Paolo
authors.initials: P
authors.lastname: Sapienza
authors.forename: Luca
authors.initials: L
authors.lastname: Dimarzo
mesh_terms: D004691:Endarterectomy / Q000009:adverse effects; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery*; D006119:Groin / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012039:Regional Blood Flow; D012086:Reoperation; D012189:Retrospective Studies; D012384:Rome; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency