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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2008 June;15(2):95-102
Total occlusion of the superficial femoral artery: comparison of ringstripper endarterectomy versus endoluminal femoro-popliteal bypass
Piffaretti G., Tozzi M., Lomazzi C., Rivolta N., Riva F., Castelli P.
Vascular Surgery-Department of Surgery University of Insubria, Varese, Italy
Aim. The aim of this study was to evaluate the results and compare two different techniques for the revascularization of total occlusion of the superficial femoral artery.
Methods. Between February 2002 and June 2006, 19 patients underwent remote endarterectomy (group A, N.=12) or endoluminal femoro-popliteal bypass (group B, N.=7) for total occlusion of the superficial femoral artery. Remote endarterectomy was performed using the Völlmar ringstripper; endoluminal femoro-popliteal by-pass was performed through a groin cut-down, endarterectomy of the common femoral artery, balloon-angioplasty of the entire superficial femoral artery and subsequent stent-graft deployment. Kaplan-Meier life-table analysis was used to determine primary, primary-assisted or secondary patency rate.
Results. Technical success was achieved in all patients in group A and in 86% of group B. Mean ankle-brachial index increased from 0.54 preoperatively to 0.76 postoperatively in group A, in group B increased from 0.51 to 0.86 (mean increase 0.27 vs 0.35, P=NS). Mortality was not observed in both the groups. Overall, immediate limb salvage was 100%. Neither early superficial femoral artery thrombosis nor stent-grafts thrombosis were observed. Mean follow-up averaged 25±16 months in group A and 34±12 months in group B (P=NS). No patients were lost to follow-up. Amputations was never required. During the follow-up, 3 late occlusions in group A, and 1 in group B were noted. Primary patency rates at 12-months and 24-months were 100% and 62.5% in group A, and 85.7% and 64.2% in group B by life-table analysis (log-rank test: P=0.01). Conclusion. Remote endarterectomy proved to be better than endoluminal femoro-popliteal by-pass for total occlusion of the superficial femoral artery; both the procedures showed similar results of conventional above-knee synthetic by-pass but lower patency rate than vein by-pass.