Print this page2006 Abstracts: Remote Endarterectomy: Is It an Effective Modality in the Treatment of Arterial Occlusions?
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Timothy P. Milner, MD, Chris Scibelli, MD, Hosam F. El Sayed, MD, George H. Meier, MD, Marc H. Glickman, MD, Martin A. Fogle, MD, Richard J. DeMasi, MD, Robert G. Gayle, MD, Noel Parent, MD, Gordon K. Stokes, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
Introduction:
Superficial femoral artery (SFA) occlusion is the most common infrainguinal arterial lesion treated clinically by vascular surgeons. The gold standard for intervention is bypass, usually using autogenous vein. However, many patients will have multiple co morbidities that will preclude major surgical intervention and a significant number will not have suitable autogenous conduit. With endovascular treatment, many new options for SFA disease exist, most with inferior results compared to bypass. Remote endarterectomy (RE) is an evolving modality that has been used sporadically by vascular surgeons for therapy of SFA occlusion. This report reviews the largest single center experience with this technique in the United States.
Methods:
A retrospective review of all patients who underwent remote SFA endarterectomy in our institution was performed. The indications, technical and clinical success, complications and outcomes in those patients were reviewed. Statistical analysis was by Chi Square testing, with significance defined as P < .05.
Results:
Sixty six remote endarterectomy procedures for SFA occlusive disease were performed in 62 patients between September 2003 and August 2004. There were 46 males and 20 females. The ages ranged between 42 to 87 years (mean 64.9 years). The procedure was performed for claudication in 45.4% of cases and for limb salvage (rest pain, ulcer and gangrene) in 54.6% of cases. Technical success was achieved in 53 cases (80.3%). Complications related to the procedure happened in 10 patients (18.9%). The mean follow up was 11.2 months (range 0 to 23 months). Mortality occurred in 3 (4.5%) of patients during post operative follow up and was not related to the procedure. Limb salvage rate was 93.9% with only 4 major amputations, all in the limb salvage subset. Of the technically successful interventions, only 28% were completely successful without further intervention. The majority of these patients either failed or needed further endovascular intervention.
Conclusion
Remote endarterectomy for SFA occlusive disease is a safe treatment, especially useful for patients who do not have adequate vein conduit. Nonetheless, given the poor long term success of this procedure, remote endarterectomy should be reserved for patient without any other alternative method of treatment and lacking autologous conduit. While this procedure can be done safely, it remains a procedure of last resort in our hands.