Remote superficial femoral artery endarterectomy: Multicenter medium-term results

OBJECTIVE: The results of percutaneous transluminal angioplasty, atherectomy, and laser angioplasty for the treatment of long-segment (>10 cm) superficial femoral artery (SFA) occlusive disease have proved disappointing. Remote superficial femoral artery endarterectomy (RSFAE) is a minimally invasive procedure, performed through a single limited groin incision that may offer patency rates comparable with those of above-knee femoropopliteal (AKFP) bypass graft. In this retrospective multicenter study the medium-term results of RSFAE are examined. METHODS: Sixty patients were included in this study. Indications for the procedure were claudication in 52 patients and limb salvage in eight patients. RSFAE was performed with the MollRing Cutter device through a femoral arteriotomy. The distal "flap" of atheroma was anchored by balloon/stent angioplasty through the femoral arteriotomy. All patients underwent a follow-up examination with serial color flow ultrasound scanning. RESULTS: Ten patients with heavily calcified SFAs failed as "intentions to treat"; these patients underwent AKFP bypass grafting. The mean length of the endarterectomized SFAs was 22.3 cm (range, 8-37 cm). The primary cumulative patency rate by means of life-table analysis was 61.4% +/- 9% (SE), (mean, 12.9 months; range, 3-36 months). During follow-up, percutaneous transluminal angioplasty was necessary in 14 patients, for a primary-assisted patency rate of 82.6% +/- 8%. The locations of the restenoses after RSFAE were evenly distributed along the endarterectomized SFAs. There were no deaths and one wound complication (hematoma), and the mean hospital length of stay was 1.4 days +/- 0.8 days. CONCLUSIONS: RSFAE is a safe and moderately durable procedure. If long-term patency rates are similar to those of AKFP bypass graft, RSFAE may prove to be a minimally invasive adjunct for the treatment of SFA occlusive disease that will lower operative morbidity, reduce hospital LOS, and shorten recuperation.     

Results of endovascular superficial femoral endarterectomy

BACKGROUND: Endovascular superficial femoral artery (SFA) endarterectomy with a ring stripper/cutter and distal stenting has been suggested to have a patency comparable with above-knee bypass surgery. We report our initial experience with this technique. METHODS: Seventeen patients (13 men and 4 women; mean age, 64 years) with SFA occlusion and above-knee popliteal reconstitution underwent attempted remote endarterectomy with a ring cutter system combined with primary stenting of the distal end point. Analysis was performed in a prospective manner with patency rates determined by Kaplan-Meier life-table analysis. RESULTS: The indication for operation was claudication in 8 patients, rest pain in 6, and tissue loss in 3. Initial technical success was achieved in 11 patients (65%). Reasons for technical failure included SFA perforation (4), inability to traverse a calcified/diseased segment (1), and inability to retract/remove the ring cutter (1). Life-table analysis of all patients revealed a primary patency at 1 year of 26% +/- 11%. Primary-assisted patency was 38% +/- 12% at 1 year, with 59% of patients ultimately requiring surgical bypass grafting. In patients in whom initial technical success was achieved, the 1-year primary and primary-assisted patency rates were 40% and 59%, respectively. There were four reocclusions requiring surgical revascularization with below-knee popliteal (2) or tibial (2) bypass grafting, 1 symptomatic restenosis requiring repeat angioplasty, and 1 symptomatic restenosis treated conservatively. CONCLUSION: The results of endovascular SFA endarterectomy were disappointing, with technical success in less than two thirds of patients and a 1-year primary patency of only 26%. Remote SFA endarterectomy appears less effective than above-knee femoropopliteal bypass grafting, and after early failure, patients may require more distal revascularization for limb salvage.     

Open endarterectomy of the SPT segment: an experience

The purpose of the study was to evaluate the results of open endarterectomy in short atherosclerotic occlusions of the SPT segment (superficial femoral, popliteal, and tibioperoneal arteries). Retrospectively, records from July 1999 to June 2004 of patients who underwent open endarterectomy of lower limb arteries were verified; 63 patients with 66 lesions had open endarterectomy of the SPT segment as a primary procedure. At the time of this study, there were 57 patients alive and six dead, with the cause of death being unrelated to the procedure. The patients had a mean age of 71 +/- 10.73 years, and there were 18 females and 45 males. All patients underwent routine follow-up at 1, 3, 6, and 12 months and yearly thereafter. Routine clinical examination and ultrasound were done to assess the outcome. The mean length of endarterectomized superficial femoral artery was 7.42 +/- 3.66 cm (range 2-15). The lesions involved were the superficial femoral, popliteal, and tibioperoneal arteries (SPT segment). The primary cumulative patency rate by means of life-table analysis was 48.8% at 5 years (mean 12.7 months, range 1-60). During follow-up, percutaneous transluminal angioplasty was necessary in nine patients, for a primary assisted patency rate of 85.1% at 5 years. The location of recurrent stenoses after endarterectomy was usually at one of the ends of the endarterectomy site. Once a preferred technique, endarterectomy is now overshadowed by bypass procedures. Our clinical experience suggests that, in a select group of patients with SPT segment occlusions, open endarterectomy is technically feasible and should be used in cases with insufficient vein for bypass grafting. It also can be used as an alternative to allow the long saphenous vein to be reserved for a bypass procedure in the future.     

Early results of external iliac artery stenting combined with common femoral artery endarterectomy

PURPOSE: The endovascular approach to external iliac artery (EIA) disease extending into the common femoral artery (CFA) has been avoided because of problems with stent placement across the inguinal ligament. Surgical treatment for this disease distribution includes extensive endarterectomy or bypass procedures or both. We report our initial experience with a combined open and endovascular approach to these patients. METHODS: We performed a retrospective analysis of all patients who underwent intraoperative EIA stenting after CFA endarterectomy/patch angioplasty between 1997 and 2000. Stents were positioned to end at the proximal endarterectomy endpoint, without crossing the inguinal ligament. Technical success, hemodynamic success, and clinical success were determined according to Society of Vascular Surgery/International Society of Cardiovascular Surgery criteria. Life-table analysis was performed for patency. RESULTS: Thirty-four patients (mean age, 68 years; 23 male, 11 female) had combined endovascular and open treatment of iliofemoral occlusive disease. Indications were claudication in 41% and critical limb ischemia in 59%. Femoral reconstruction included endarterectomy with patch angioplasty in all patients. EIA stent deployment incorporated the stenotic iliac segment and the proximal endpoint of the endarterectomy in all patients. Four patients (12%) also needed common iliac angioplasty at the same time for proximal iliac disease, and 14 patients (41%) also needed distal revascularization for associated femoropopliteal or tibial disease. Technical success and hemodynamic success were achieved in 100% of patients. Clinical success was achieved in 97% of patients. The mean postoperative increase in ankle-brachial index in patients with inflow procedures only was 0.36 (range, 0.1 to 0.85). The overall complication rate was 15%. With a mean follow-up period of 13 months (range, 0.5 to 28 months), 1-year primary patency and primary-assisted patency rates were 84% and 97%, respectively. No perioperative mortality was seen. CONCLUSION: EIA stenting as an adjunct to CFA endarterectomy/patch angioplasty allows for more localized surgery than conventional bypass. This approach also allows a better interface between the stent and endarterectomy than staged preoperative stenting. Technical success and early patency rates are excellent.     

Extraperitoneal iliac endarterectomy in the treatment of multilevel lower extremity arterial occlusive disease

The traditional approach to the surgical correction of lower extremity ischemia resulting from combined aortoiliac and femoropopliteal disease has consisted of aortofemoral bypass as the initial step. This operation is of considerable magnitude, mandates the use of prosthetic material, and may not adequately relieve distal ischemia. Extraperitoneal iliac endarterectomy is an operation of lesser magnitude and does not require the use of prosthetic material. When applied to selected patients with multilevel disease, it can be conveniently and expeditiously combined with distal bypass and deep femoral repair, femorofemoral bypass, or both for the simultaneous and complete correction of multilevel disease. In the past 10 years, 65 patients underwent simultaneous extraperitoneal iliac endarterectomy in combination with an outflow procedure for the correction of multilevel lower extremity arterial occlusive disease. Using a two-team approach, operative time averaged 3 hours. Operative mortality was 5 percent. The procedure was combined with femoral endarterectomy in 60 patients, with femoropopliteal-to-tibial bypass in 30 patients, and with femorofemoral bypass in 10 patients. The life table patency for iliac endarterectomy was 100 percent at 6 years, whereas patency for the associated outflow procedures was 87 percent at 6 years. These results indicate that extraperitoneal iliac endarterectomy is uniquely suited for combination with distal procedures to permit the simultaneous repair of combined aortoiliac and femoropopliteal disease in a single operation of reasonable magnitude.     

Oscillating loop endarterectomy for peripheral vascular reconstruction

A new technique for endarterectomy of the aorta, iliac, femoropopliteal, and three distal vessels of the lower leg is a safe and predictable method of endarterectomy that has proved to be effective. By the use of this technique the superficial femoral artery and its collateral branches are opened, considerably increasing the blood flow to the lower leg. Increased knowledge concerning thrombogenic enzymes, released when cleavage of the arterial wall is performed, has led to the use of antiplatelet and anticoagulative drug therapy. This has significantly enhanced the patency of the endarterectomized vessel. Today, with many patients having the saphenous veins harvested for coronary bypass or needing these veins for future bypass surgery, it seems reasonable to perform an endarterectomy of the femoral artery.     

Teflon guide-wire-assisted semi-closed Vollmar endarterectomy of the superficial femoral artery. A review of 25 cases and the state of the art from a literature review

In this retrospective study, we analysed 25 guide-wire-assisted Vollmar endarterectomies of an occluded superficial femoral artery. In 96% of the cases, the patient suffered from a Fontaine stage III or IV. After a mean follow-up of 24.7 months, limb salvage is 96%. The patency rate is 84% which is comparable with a femoropopliteal bypass with a reversed greater saphenous vein graft. We advocate the Vollmar endarterectomy as a valuable alternative surgical treatment for occlusive superficial femoral artery in the absence of a greater saphenous vein or in young smoking patients (< 65 years).     

Teflon Guide-Wire-Assisted Semi-closed Vollmar Endarterectomy of the Superficial Femoral Artery

In this retrospective study, we analysed 25 guide-wire-assisted Vollmar endarterectomies of an occluded superficial femoral artery. In 96% of the cases, the patient suffered from a Fontaine stage III or IV. After a mean follow-up of 24.7 months, limb salvage is 96%. The patency rate is 84% which is comparable with a femoropopliteal bypass with a reversed greater saphenous vein graft. We advocate the Vollmar endarterectomy as a valuable alternative surgical treatment for occlusive superficial femoral artery in the absence of a greater saphenous vein or in young smoking patients (< 65 years).     

Endovascular femoropopliteal bypass: Early human cadaver and animal studies

We report herein a feasibility study of a minimally invasive endovascular femoropopliteal bypass procedure. The steps include the following: (1) a small groin incision to expose the femoral artery, (2) guidewire passage and mechanical dilatation of the diseased superficial femoral artery, (3) semiclosed endarterectomy of the superficial femoral artery using an expandable metal endarterectomy catheter that engages atheroma, (4) placement of a 6 mm thin-walled PTFE graft, (5) balloon dilatation of the graft to press the graft flat against the arterial wall, and (6) a standard end-to-end anastomosis of the proximal graft to the femoral artery. This technique was tested in 13 limbs from eight fresh (stored 1 to 5 days at 4° C) human cadavers (seven females and one male). Five limbs had stenotic superficial femoral artery lesions, 1 to 15 cm (mean 7.6 cm). Four limbs had occlusive lesions, 9 to 38 cm long (mean 26.8 cm). Four limbs had no disease. We successfully completed the procedure in 10 of 13 limbs. Completion arteriography showed a widely patent graft and a popliteal artery with a smooth distal graft/arterial interface in 9 of 10 limbs; one had a distal graft fold due to a size mismatch. Histologic studies of the superficial femoral artery revealed intima, atheromatous plaque, and media. We failed to complete our procedure in three limbs: two because of inadequate instruments and one because of perforation of the artery. We also performed the same procedure unilaterally in six dogs, except that no endarterectomy was performed. Each dog was an adult male of Greyhound or Labrador descent that weighed 32 to 86 kg (mean 49 kg). We achieved technical success in all six dogs and arteriographic success in four of six dogs. In two dogs completion arteriography revealed a longitudinal fold near the distal end of the graft that was attributed to a size mismatch. We conclude that endovascular femoropopliteal bypass is feasible and warrants further studies for possible clinical application.     

The profunda femoris: a durable outflow vessel in aortofemoral surgery.

Aorta-common femoral artery bypass is the standard operation for relief of aortoiliac occlusive disease. When extensive superficial femoral artery disease coexists, the profunda femoris, even in its distal portion, may be used as the outflow vessel. To test this assumption we compared cumulative patency, limb salvage, and the need for distal bypass of 134 aorta-profunda femoris and 151 aorta-common femoral artery bypasses performed consecutively for aortoiliac occlusive disease over a 12-year period. We also analyzed results of proximal (n = 103) and distal (n = 31) aortoprofunda bypasses. Angiographic and noninvasive studies showed greater disease in limbs undergoing aorta-profunda femoris bypass. However, no difference was observed in cumulative patency (91% +/- 6% vs 96% +/- 3%) or limb salvage (90% +/- 6% vs 94% +/- 3%) at 5 years. Seventeen distal bypasses in the group undergoing profunda femoris bypass and 20 distal bypasses in the group undergoing common femoral artery bypass were required to maintain limb salvage. Proximal and distal aorta-profunda femoris bypasses showed no difference in cumulative patency (91% +/- 9% vs 95% +/- 6%) or limb salvage (94% in each group) at 3 years. Standard aorta-common femoral artery and aorta-profunda femoris bypass provide cumulative patency and limb salvage exceeding 90% at 5 years; concomitant or subsequent distal bypass was required in 12% or limbs undergoing aorta-profunda femoris bypasses. Both proximal and distal profunda femoris arteries provide a durable outflow tract when aortoiliac and femoropopliteal occlusive disease are combined.     

Percutaneous transluminal angioplasty of infrarenal arteries in intermittent claudication

Percutaneous transluminal angioplasty was performed on 55 iliac and 31 femoropopliteal arteries in 71 patients with intermittent claudication (23 women, 48 men). The two-year patency rate was 80% after iliac and 41% after femoropopliteal angioplasty. In 17 femoropopliteal cases with lesions greater than or equal to 5 cm the 2-year patency rate was only 32%, but the corresponding figure for shorter lesions was 53%. Complicating haematoma appeared in 10% of the cases and the arterial state deteriorated in one patient. There was no distal embolization. Percutaneous transluminal angioplasty in intermittent claudication is indicated for all cases of occlusion or stenosis of the iliac artery and for occlusion or stenosis shorter than 5 cm of the superficial femoral or the popliteal artery.     

Endovascular femoropopliteal bypass combined with remote endarterectomy in SFA occlusive disease: initial experience.

OBJECTIVES: to evaluate the feasibility of endovascular femoropopliteal bypass in combination with remote endarterectomy of the superficial femoral artery (SFA). DESIGN: prospective, open study. MATERIALS: thirteen patients with chronic lower-leg ischaemia due to femoropopliteal occlusive disease underwent 14 SFA remote endarterectomy procedures followed by endovascular ePTFE femoropopliteal bypass. Primary endografting was performed in seven cases. The indication for endograft insertion was vessel-wall perforation during endarterectomy in the remaining seven cases. METHODS: pre- and postoperative clinicl and haemodynamic data were collected and compared. Technical problems and procedure-related complications were noted. RESULTS: initial technical success was achieved in all 14 limbs. However, four early reocclusions occurred after 1, 4, 6 and 10 weeks postoperatively. Two late reocclusions were detected after 16 and 22 months without any preceding symptoms or haemodynamic changes. Primary and secondary patency rates were 61% and 70% at two years, probably due to graft-related factors, such as lack of radial force, graft folding or kinking, and possibly altered mechanical or thrombogenetic properties after dilatation of the ePTFE graft. CONCLUSIONS: endovascular femoropopliteal endo-bypass after SFA remote endarterectomy is a feasible procedure. Further technical improvements are necessary to avoid procedure- and graft-related early failures.     

Semi-closed femoropopliteal thromboendarterectomy: a prospective study.

OBJECTIVE: to study the primary patency rates of angioscopically controlled thromboendarterectomies of the superficial femoral artery. DESIGN: prospective open study. METHODS: between 1990 and 1995, femoropopliteal thromboendarterectomies were performed in 63 patients (41 male, 22 female). Postoperative follow up was performed at 3- to 6-month intervals using non-invasive pressure measurements plus IVDSA at 1 year. RESULTS: eight patients were not evaluable, leaving 55 patients eligible for follow-up analysis. Postoperative complications (arteriovenous fistulas, false aneurysms) were observed in 5.4% of patients. Immediate perioperative occlusions occurred in 7.3%, early occlusions in 21.8% and late occlusions in 16.4% of all cases. The mean follow-up was approximately 57 months. The mean primary patency rate at 5 years was 44.5% (28 patients with the superficial femoral artery still open). Six patients died during the follow-up period. CONCLUSIONS: in contrast to the very positive reports found in recent literature, this prospective study shows a lower five-year patency rate for semi-closed femoropopliteal thromboendarterectomy than for bypass grafting. Thromboendarterectomy cannot be considered as a standard procedure in revascularisation of the femoropopliteal region.     

Remote superficial femoral artery endarterectomy: early results for TASC D lesions in patients with severe ischemia

Endovascular treatment for Transatlantic Inter-Society Consensus (TASC) D lesions of the superficial femoral artery has been disappointing. This has been attributed to a bulking atheromatous plaque. Debulking the superficial femoral artery allows for a larger lumen, whereas covering the lumen with an endograft provides in-line flow. We evaluated the intermediate results of remote superficial femoral artery endarterectomy with covered endograft placement in 18 patients. Patient demographic, vascular laboratory, and preoperative data were gathered retrospectively. The procedure was technically successful in all the patients. The mean age was 62.2 +/- 9.9 years. Ankle brachial index improved from 0.35 +/- 0.1 to 0.86 +/- 0.1. The cumulative 12-month primary patency was 42.2%, whereas assisted primary or secondary patency was 70.8%. Five endografts occluded within the 12 months. Two of those patients underwent subsequent femoral-to-below-knee bypass, whereas 2 had major amputations. Remote superficial femoral artery endarterectomy can be reasonably offered if an autogenous conduit is not available for revascularization of the superficial femoral artery.     

Eversion endarterectomy of the superficial femoral artery and end-to-side anastomosis to the deep femoral artery: An alternative to extended profundoplasty

The success of aortofemoral reconstruction in patients with superficial femoral artery occlusion depends on the restoration of a satisfactory pulsatile flow to the deep femoral artery. In 18 patients with multilevel disease, widespread involvement of the deep femoral artery, and poor distal outflow, we performed an eversion endarterectomy of the proximal segment of the superficial femoral artery and constructed an end-to-side anastomosis between this segment and the distal deep femoral artery. In 10 patients, the reconstruction was performed after thrombectomy of the occluded aortofemoral graft, and in 8 the two reconstructions were simultaneous. The actuarial patency rate was 93.5 percent at 1 year and 75.2 percent at 5 years. Four late femorodistal bypasses were performed that gave an actuarial limb salvage rate of 68.8 percent at 1 year and 61.6 percent at 5 years. In selected cases, this technique is a valid alternative to an extended profundoplasty or to a femorodistal bypass.     

Unilateral iliofemoral occlusive disease: long-term results of the semi-closed endarterectomy with the ring-stripper

Nowadays, fewer endarterectomies are performed for treatment of occlusive arterial disease; more often a bypass procedure is done. This study investigates whether the results of the semiclosed endarterectomy for unilateral iliofemoral occlusive disease indeed indicate a wider use of bypass procedures for such short obstructions. Ninety-four patients with an obstructed external iliac and common femoral artery, but with patent ipsilateral common iliac and contralateral iliac arteries, underwent 101 operations. Seven of these patients were operated on at a later stage for occlusive disease on the contralateral side. Ninety-three endarterectomies were performed, and an iliofemoral bypass graft was inserted eight times because an endarterectomy was not feasible. Sixty-two operations were performed for disabling claudication, and 39 operations were performed for limb-threatening ischemia. Eighty-five percent of the patients who underwent an endarterectomy for disabling claudication became asymptomatic. Eighty percent of the patients who underwent an endarterectomy for limb-threatening ischemia became asymptomatic or improved to claudication. After endarterectomy no deaths, false aneurysms, or infections occurred. The patency rates at 1, 5, and 10 years were 94%, 83%, and 65%, respectively. We conclude that the semiclosed endarterectomy with the ringstripper of a unilateral obstruction of one external iliac and common femoral artery can be performed with a low morbidity and without deaths and gives good long-term results.     

A twelve-year experience with the popliteal-to-distal artery bypass: the significance and management of proximal disease.

The value of the popliteal-to-distal artery bypass in limb salvage is well documented. However, the influence of progression of disease in the superficial femoral artery or proximal popliteal artery, and the role of percutaneous transluminal angioplasty of these vessels before bypass have not been adequately assessed. To evaluate these and other factors, we reviewed our experience with 153 nonsequential popliteal-to-distal artery bypasses performed over a 12-year period. Limb salvage was the indication for all procedures, and 87% of the patients were diabetic. The 5-year primary and secondary graft patency rates were 55% and 60%, respectively, and the limb salvage rate was 73%. Preoperative arteriograms were evaluated for stenosis in the superficial femoral artery or popliteal artery proximal to the graft. Fifty-six grafts with a proximal stenosis 20% or less were identified and had primary graft patency of 77% at 2 years, similar to the 70% patency for the 20 grafts placed distal to a 21% to 35% stenosis. The 18 grafts placed distal to a stenosis greater than 35% had 53% 2-year primary graft patency (p = 0.25). Percutaneous transluminal angioplasty of a superficial femoral artery or popliteal artery stenosis (24% to 85% luminal narrowing) in 19 limbs resulted in 68% 2-year graft patency, not significantly lower than grafts with 35% or less proximal stenosis (75%, p = 0.25). Other factors associated with significant decreases in graft patency included a vein graft diameter less than 3.0 mm, a dorsalis pedis outflow site, and poor quality outflow. Thus the popliteal-to-distal bypass is a durable procedure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Early results of stent-grafting to treat diffuse aortoiliac occlusive disease

INTRODUCTION: Diffuse aortoiliac occlusive disease or isolated external iliac artery occlusion >or=10 cm long typically are treated with surgical bypass grafting because of limited durability of stent placement. We evaluated the results of stent-graft placement as an option for treatment of these diseases. METHODS: Demographic data for patients undergoing stent-grafting in one or more iliac artery segments were recorded. Technical, clinical, and hemodynamic success, and aortoiliac primary and secondary patency were analyzed with Society for Vascular Surgery/American Association for Vascular Surgery criteria. RESULTS: Thirty-four consecutive patients underwent stent-graft treatment because of rest pain (65%) or tissue loss (35%). Mean patient age was 63 years, and 38% of patients were women. Ninety-one percent of patients had hypertension, 71% had coronary artery disease, 21% had renal insufficiency (serum creatinine > 2.0 mg/dL), and 26% had diabetes; 71% were active smokers. TransAtlantic Inter-Society Consensus C or D disease was present in 85% of patients, complete common or external iliac artery occlusion was present in 41%, and external iliac artery disease requiring treatment was present in 94% of patients. Mean lesion length was 13.7 +/- 8 cm. Technical, hemodynamic, and clinical success was achieved in all patients in whom the lesion could be crossed with a wire. Ankle-brachial index increased from.30 +/-.03 to.59 +/-.04. Self-expanding stent grafts were used (Wallgraft, Boston Scientific, Boston, Mass, in 88% of patients; Viabahn, W. L. Gore, Flagstaff, Ariz, in 12% of patients). Concomitant common femoral endarterectomy was performed in 53% of patients. At 12 months, primary patency was 70% and primary assisted patency was 88%. Four stent grafts became occluded because of distal external iliac artery or proximal common femoral artery disease, which required subsequent common femoral endarterectomy and either external iliac artery stent grafting or extraanatomic bypass grafting. Eighty percent (four of five) of primary patency failures were in patients who did not undergo concomitant common femoral endarterectomy at initial stent graft placement. CONCLUSION: Early results of stent-graft placement to treat diffuse aortoiliac occlusive disease appear better than our recent experience with stenting alone. Concomitant common femoral endarterectomy or better assessment of femoral disease may improve durability.     

Is semi-closed endarterectomy of the superficial femoral artery combined with a short venous bypass in case of insufficient venous material an acceptable alternative for limb-threatening ischemia?

BACKGROUND: The aim of this study was to analyse the results of infragenual arterial revascularisation using semiclosed endarterectomy of the superficial femoral artery combined with a short venous bypass in patients with critical leg ischemia and insufficient venous material for a straightforward femorocrural reconstruction. METHODS: From December 1990 through December 1998 thirty patients were studied (22 males and 8 females; mean age 65 years, range 31-92 years). The mean follow-up was 26 months (range 1-96 months). Cumulative primary patency and limb salvage rates were calculated according to life-table analysis. RESULTS: The cumulative primary patency was 60.3% at 1 year and 48.4% at 3 years. The limb salvage rate was 68.6% at 1 and at 3 years. CONCLUSIONS: In patients with limb-threatening ischemia and lack of venous material for a straightforward venous femorocrural bypass, semi-closed endarterectomy of the superficial femoral artery combined with a short popliteo-crural bypass provides a good alternative.     

Patency of superficial femoral vein employed as a crossover femoral artery bypass conduit

This study assesses the patency of superficial femoral vein used as a crossover femoral artery bypass conduit in patients presenting either with localized groin sepsis, generalized sepsis or in patients with occluded or heavily diseased superficial femoral artery outflow. Twenty patients were followed prospectively with femoral crossover grafts constructed of superficial femoral vein. Twelve patients presented with sepsis and 8 with chronic ischemia from iliac artery occlusion and severely diseased superficial femoral artery outflow. Graft patency was assessed with regular duplex ultrasound examination. There was one perioperative death. Six patients died during the follow-up period. Mean follow-up time was 24.3 months. No graft occluded or required revision. There was no limb loss, graft infection, or graft hemorrhage. Superficial femoral vein offers an effective femoral crossover bypass graft in patients with either localized/generalized sepsis or disadvantaged outflow tracts.