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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2000 June;41(3):433-9

lingua: Inglese

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

Lermusiaux P., Martinez R., Londe J. F., Castellani L.

From the Depart­ment of Vas­cular Sur­gery, Trous­seau Hos­pital, Uni­ver­sity of ­Tours, ­Tours, ­France


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.

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