title: Single-Center Experience With Remote Endarterectomy for the Treatment of Long-Segment Superficial Femoral Artery Occlusion: Long-Term Results.
abstract: OBJECTIVE
  Remote endarterectomy (RE) is a relatively minimally invasive procedure as an alternative to femoropopliteal above-knee bypass for the treatment of long-segment superficial femoral artery (SFA) occlusion. The objective of this study was to report our experience and to evaluate the long-term outcome.
  
  
  METHODS
  Single-center nonrandomized retrospective study with prospective collection of patients' data.
  
  
  METHODS
  Twelve patients (11 men; mean age 72 years, range 55-81 years) with long (>10 cm) SFA occlusion underwent RE followed by stent (aSpire) placement at the distal end of the endarterectomy. All patients had at least 2 tibial vessels outflow. Indications were severe claudication in 9 (75%), rest pain in 1(8%), and gangrene in 2 (17%) cases. Technical, hemodynamic success rates and clinical improvement were recorded. Assessment of patency and limb loss was made at a mean follow-up of 50 months (range 12-66 months).
  
  
  RESULTS
  Technical success rate was 100%. Immediate hemodynamic and clinical improvement were 92% and 75%, respectively. The mean increase in the Ankle-Brachial pressure index was 0.24. The primary, primary-assisted, and secondary patency rates were 50%, 83%, and 100%, respectively. The perioperative mortality rate was 8% (one death due to myocardial infarction). There was no early (30-day) reocclusion. During the follow-up, 5 (41.6%) cases underwent 7 reinterventions, all by endovascular means. The amputation rate was 16% (2 of 12).
  
  
  CONCLUSIONS
  The RE for long SFA occlusion is a feasible procedure with acceptable short- and long-term outcomes in the presence of distal arterial outflow. Good long-term patency and limb salvage can be achieved with close surveillance and with the compensation of endovascular reintervention procedures.
authors.affiliation: Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece christoskarathanos@yahoo.gr.
authors.forename: Christos
authors.initials: C
authors.lastname: Karathanos
authors.affiliation: Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spanos
authors.affiliation: Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Vassileios
authors.initials: V
authors.lastname: Saleptsis
authors.affiliation: Royal Liverpool University Hospital, Liverpool Vascular and Endovascular Service, Liverpool, United Kingdom.
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Koutsias
authors.affiliation: Department of Vascular Surgery, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Giannoukas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D003251:Constriction, Pathologic; D004691:Endarterectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D006115:Greece; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: peripheral arterial disease; remote endarterectomy; superficial femoral artery occlusion