Clinical outcome after re-occlusion of initially successful remote endarterectomy of the superficial femoral artery.

Full Abstract

AIM:The clinical consequences of re-occlusion after initially successful arterial revascularization procedures might be as important as patency when it comes to procedure selection. This study evaluates the clinical consequences of re-occlusion after initially successful remote superficial femoral artery endarterectomy (RSFAE), in particular the recurrence and severity of symptoms and the need for re-intervention or amputation. METHODS: A total of 239 successful RSFAEs were performed with a mean endarterectomized segment of 30 cm (10 to 45 cm) between March 1994 and December 2003 in 214 patients (144 males, 163 procedures) with a median age of 63 years (39 to 89 years). Indications for operation were Rutherford category 3 in 174 procedures (73%), Rutherford category 4 in 27 procedures (11%), and Rutherford category 5 in 38 procedures (16%). The incidence and time interval of re-occlusion with the presenting symptoms were recorded as well as the therapeutic consequences. RESULTS: A total of 79 (33%) re-occlusions occurred (40 males, 41 procedures; 34 females, 38 procedures). Eighty percent of patients still had improved or unchanged symptoms following re-occlusion compared to the initial indication for operation, 18% had become worse and 2% were unknown. The mean time between RSFAE and re-occlusion was 17 months (1 day to 88 months). A total of 36 re-interventions were performed: 7 percutaneous recanalisations (one followed by thrombolysis), 5 percutaneous thrombolyses, 1 thrombectomy, 21 venous and 2 prosthetic femoropopliteal bypasses. A further three venous bypasses were planned. Five (14%) of these re-interventions were acute with an overall median time interval between re-occlusion and re-intervention of 41 days (0 to 68 months). Two below-knee amputations were performed: one the same day of re-occlusion, 44 months after RSFAE and one 11 days after re-occlusion, 30 days after RSFAE. CONCLUSION: The clinical consequences of re-occlusion after remote endarterectomy for long occlusive disease of the superfricial femoral artery, from a mixed patient population with 27% ischemic rest pain and gangrene, were mild with 31 elective and only five acute re-interventions and two below-knee amputations.

Author information

Author/s: Smeets, L (L); Huijbregts, H J T A M (HJ); Ho, G H (GH); De Vries, J-P P M (JP); Moll, F L (FL);

Affiliation: Department of Vascular Surgery, Twenteborg Hospital, Almelo, The Netherlands. smeets_luuk(-atsign-)hotmail.com

Journal and publication information

Publication Type: Evaluation Studies; Journal Article

Journal: The Journal of cardiovascular surgery (J Cardiovasc Surg (Torino)), published in Italy. (Language: eng)

Reference: 2007-Jun; vol 48 (issue 3) : pp 309-14

Dates: Created 2007/05/16; Completed 2007/08/30;

PMID: 17505435, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

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