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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2018 Jan 09

DOI: 10.23736/S0021-9509.18.10353-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

The DETOUR procedure: no more need for conventional bypass surgery?

Dainis KRIEVINS 1 , Janis SAVLOVSKIS 2, Natalija EZITE 2, Andrew HILL 3, Kaspars KISIS 1, Marcis GEDINS 1, Edgars ZELLANS 1, Andrew HOLDEN 4

1 Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia; 2 Department of Invasive Radiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia; 3 FRACS, Auckland City Hospital, Vascular Services, Auckland, New Zealand; 4 Department of Radiology, FRANZCR, Auckland City Hospital, Auckland, New Zealand


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BACKGROUND: Long segment occlusive disease in the superficial femoral artery remains a treatment challenge despite advances in open surgical and endovascular approaches. We report initial clinical results of an entirely new procedure to perform femoropopliteal bypass using the DETOUR System to create a stentgraft bypass which originates in the SFA, travels through the femoral vein, and ends in the popliteal artery, bypassing the diseased segment.
METHODS: Review the initial results of the first five patients at a single site enrolled in IRB-approved, prospective clinical study using the DETOUR System. All patients signed informed consent with planned 2-year follow-up.
RESULTS: First-in-human patients were treated in New Zealand from December 2013 to June 2014. After modifications to the technique and devices had significantly refined the procedure, the Detour I Trial commenced. A cohort of patients treated in that multi-national trial were treated in Latvia from January 2015 to October 2015. The initial five patients in this cohort (age 64.5 ± 8.5 years) with long (25.5±8.3 cm) femoral artery occlusions were treated at a single clinical site. TORUS Stent Grafts were successfully implanted in all 5 patients (100%) using an 8F delivery system. There were no perioperative 30-day major adverse events (death, major bleeding, deep vein thrombosis, target vessel revascularization or major amputation) observed. At 24 months’ follow-up, the primary patency rate was 80% (4/5) and secondary patency rate was 100% (5/5). Significant improvement in ankle-brachial index and Rutherford class were observed in all patients. There have been three secondary procedures performed in three patients (stent graft occlusions at 12 and 16 months and one proximal stent edge stenosis). The venous function has not been damaged or compromised in any patient.
CONCLUSIONS: Early results suggest that properly-selected patients with long-segment occlusive disease above the knee can be safely treated using the DETOUR System for percutaneous bypass, with favorable clinical outcomes extending to 2 years. Further clinical investigation is warranted to evaluate the role of this approach in the treatment of long femoral lesions.


KEY WORDS: Endovascular treatment of femoral artery - TORUS Stent Graft - DETOUR system - Superficial femoral artery occlusion

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Publication History

Article first published online: January 9, 2018
Manuscript accepted: January 3, 2018
Manuscript received: December 4, 2017

Cite this article as

Krievins D, Savlovskis J, Ezite N, Hill A, Kisis K, Gedins M, et al. The DETOUR procedure: no more need for conventional bypass surgery? J Cardiovasc Surg 2018 Jan 09. DOI: 10.23736/S0021-9509.18.10353-3

Corresponding author e-mail

dainis.krievins@stradini.lv