Endarterectomy for localized lesions of the superficial femoral artery at the adductor canal

Although femoropopliteal bypass is the accepted treatment for diffuse atherosclerotic disease of the superficial femoral artery, endarterectomy may be appropriate for short segmental lesions at the level of the adductor tendon. Over a 25-year period, 94 patients underwent localized endarterectomy of short (less than 15 cm) segments of the distal superficial femoral artery. There were two perioperative deaths in the series, for an operative mortality rate of 2.1%. The long-term patency rate was substantial, with 66% of the reconstructions open at 3 years and 57% open 7 years after operation. Improved results were obtained when a semiclosed method was possible with a transverse distal arteriotomy to prevent subintimal dissection. There was a trend toward improved patency in patients with claudication and those who underwent endarterectomies less than 7.5 cm in length. Patency appeared independent of popliteal outflow. Amputation was initially avoided in 82% of patients presenting with threatened limbs. These results suggest that superficial femoral endarterectomy may be a viable alternative to femoropopliteal bypass when the disease is localized to the adductor canal.