ORIGINAL ARTICLE  LATEST ADVANCES IN TREATING FEMOROPOPLITEAL DISEASE 

The Journal of Cardiovascular Surgery 2018 April;59(2):172-7

DOI: 10.23736/S0021-9509.18.10353-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

Dainis KRIEVINS ¹ ✉, Janis SAVLOVSKIS ², Natalija EZITE ², Andrew HILL ³, Kaspars KISIS ⁴, Marcis GEDINS ⁴, Edgars ZELLANS ¹, Andrew HOLDEN ⁵

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 Vascular Services, Auckland City Hospital, Auckland, New Zealand; ⁴ Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; ⁵ Department of Radiology, Auckland City Hospital, Auckland, New Zealand

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 percutaneous femoro-popliteal bypass using the DETOUR System. First-in-human patients were performed 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.
METHODS: Review of initial results in the first five patients treated 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. The DETOUR System was used to create a stent graft bypass which originates in the SFA, travels through the femoral vein, and ends in the popliteal artery, bypassing the diseased segment.
RESULTS: A cohort of patients were treated in Latvia from January 2015 to October 2015. The initial five patients in this cohort (age 67.2±11.4 years) with long femoral artery occlusions (29.5±14.1 cm) 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 primary assisted patency was 100% (5/5). Significant improvement in ankle-brachial index and Rutherford class were observed in all patients. There was a single secondary procedure performed in these patients (proximal stent edge stenosis at 24 months). 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 procedures - Femoral artery - Vascular grafting - Arterial occlusive diseases