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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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ABOVE KNEE LESIONS  NEW DEVELOPMENTS IN THE TREATMENT OF LOWER LIMB OCCLUSIVE DISEASE


The Journal of Cardiovascular Surgery 2006 August;47(4):385-91

lingua: Inglese

Remote superficial femoral artery endarterectomy and distal aSpire stenting: results of a multinational study at three-year follow-up

Rosenthal D. 1, Martin J. D. 2, Smeets L. 3, Devries J. P. 4, Gisbertz S. 4, Wellons E. D. 1, Moll F. 3

1 Department of Vascular Surgery Atlanta Medical Center, Atlanta, GA, USA
2 Department of Vascular Surgery Anne Arundel Medical Center, Annapolis, MD, USA
3 Department of Vascular Surgery University Medical Center, Utrecht, The Netherlands
4 Department of Vascular Surgery St. Antonius Hospital, Nieuwegein, The Netherlands


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Aim. The aim of this study was to examine the results of remote superficial femoral artery endarterectomy (RSFAE) in conjunction with distal aSpire® stenting in a multinational study.
Methods. RSFAE is a minimally invasive procedure performed through a limited groin incision. A total of 210 patients were included in this study. The indications for the procedure were claudication in 158 (75%) patients and limb salvage in 52 (25%). After RSFAE the outflow tract atheromatous plaque was “tacked” with the aSpire stent, which is an expanded polytetrafluoroethylene (ePTFE) covered nitinol stent with high radial strength, yet it is flexible enough to withstand the compressive forces at the knee joint. Prior to stent deployment, if the stent position is not in optimal position, it can be “wrapped down”, repositioned and re-expanded. Therefore, not only is the plaque end point tacked, but the collaterals are preserved as well. All patients underwent follow-up examination with serial color-flow duplex ultrasound scanning.
Results. The mean length of endarterectomized superficial femoral arteries (SFAs) was 28.2±6.2 cm (range 15-43 cm). The primary cumulative patency rate by means of life-table analysis was 60.6±4.8% (SE) at 33 months, (mean 17.1 months; range 1-33 months). During follow-up percutaneous transluminal balloon and/or stent angioplasty was necessary in 50 patients for a primary assisted patency of 70.2±4.8% at 33 months. The locations of the restenosis after RSFAE were evenly distributed along the endarterectomized artery. There were 2 deaths (myocardial infarctions), 12 (5.7%) wound complications (7 hematomas, 5 skin edge sloughs) and the mean hospital length of stay was only 1.3±0.5 days.
Conclusion. RSFAE with distal aSpire stenting is a minimally invasive, safe durable procedure for the treatment of long-segment SFA occlusive disease.

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