Semiclosed endarterectomy for long superficial femoral artery atherosclerotic occlusive disease. One-year angiographic results.

BACKGROUND: The anatomic results of endarterectomy of long occlusive lesions in the superficial femoral artery (SFA) are required for reconsidering this procedure and comparing the results with those of newly developed endovascular techniques. We designed a prospective study to determine the arteriographic findings one year after a successful semiclosed endarterectomy of long occlusive lesions in the SFA. METHODS: From January 1995 until July 1996, an endarterectomy in the SFA was attempted in 12 successive patients and was successfully performed in 10 patients (6 men and 4 women), with an average age of 73 years (range 66 to 90 years). Indications for successfully performed procedures were claudication in 6, non healing ulcer in 2, local gangrene in 2 patients. The mean length of the occlusion was 17 cm (12-33). Six patients had poor run-off with 0 to 1 patent tibial artery. The mean length of the endarterectomised segment was 31 cm (27-39). An angioscopy and an angiography were performed in all procedures. There were no postoperative complications. All patients had an angiography at 12 months or before because of ipsilateral disease. Primary angiographic patency was defined as patency of the treated artery with stenosis of less than 30%. A short stenosis was defined as <5 cm. These lesions were an indication of percutaneous balloon angioplasty (PTA) and the final results were listed as secondary patency. RESULTS: Angiography revealed 3 patent arteries, 5 short stenosis, 2 long stenosis and no occlusions. The primary patency rate was 30% at 12 months. The secondary patency was 80% with a mean follow-up of 19 months (ranging from 13 to 25 months). The mortality and amputation rate at 12 months was nil. CONCLUSIONS: Despite a modern intraoperative control, there was a high incidence of restenosis after semiclosed endarterectomy performed for long occlusive lesions of the SFA. As a result of a close surveillance and PTA, the secondary patency at one year was good. Before a widespread use of newly developed endovascular techniques, comparative patency studies with the mere endarterectomy should be performed. Endarterectomy followed by a PTA in cases of restenosis, is an alternative to bypass when the vein is not available.