Balloon-expandable, radially reinforced ePTFE relining of the superficial femoral artery after remote endarterectomy.

Aim. The aim of this paper was to evaluate the mid-term results of remote endarterectomy and balloon-expandable, radially reinforced ePTFE endograft uplining of the superficial femoral artery (SFA) for long occlusions. Methods. One hundred and two limbs in 92 patients were included in this prospective, multicenter study. Indications were disabling claudication (n=74), restpain (n=10) and tissue loss (n=16) due to an SFA occlusion of at least 10 cm in length. Remote endarterectomy of the SFA using a modified ringcutter in an over-the-wire technique, was followed by implantation of a balloon-expandable Enduring endovascular graft. Control visits were performed at 1, 3 and 6 months postprocedure and every half year from then on. Follow-up protocol included physical examination, Doppler ankle-brachial index measurement and, in case of doubt, duplex examination. Results. A technical success rate of 98% was achieved. Mean follow-up was 36 months. Four patients were lost to follow-up and 17 patients died of nondevice-related causes. The primary, primary assisted and secondary patency rates were 68%, 73% and 97.5% at 1 year and 50%, 60%, and 89% at 3 years, respectively. Conclusion. Although technical success rate is high and early patency rates are good, mid-term results are inferior to those of conventional femoro-popliteal synthetic bypass grafts. In order to become competitive to conventional bypass surgery, further technical refinements will be necessary, especially to overcome the problem of stenoses at the distal transition zone.