Eversion Femoral Endarterectomy for Iliofemoral Occlusive Disease: A Description of Technique and Series of Cases

Kronick, Matthew; Saiyed, Natasha; Norris, Marc A.; Hadro, Neal C.; Morris, Marvin E.

doi:10.1016/j.avsg.2017.12.005

Cited by 9 publications

(3 citation statements)

References 12 publications

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“…Common femoral artery transection has been well described, 1 with multiple studies to assess its performance. 9 , 10 However, compared to CFA transection, our technique of patchless profundoplasty allows better visualization of the end point of the endarterectomy in the PFA and easier placement of a tacking suture if needed; has a lower chance of purse-stringing compared to an end-to-end anastomosis; allows closer procedural similarity to the carotid eversion endarterectomy technique; and avoids a transverse suture line, which may need to be cut in case of revision.…”

Section: Discussionmentioning

confidence: 99%

“…The other autologous techniques described include using a piece of the SFA as a patch, 7 but this requires ligation of the SFA and loss of the anatomic continuity of the SFA if future revisions or interventions are pursued. A technique of creating longitudinal arteriotomies along the SFA and PFA in which a patch is used 8 has been modified and demonstrated in a video: 9 the use of a patch is mitigated by folding the SFA and PFA together to patch themselves. This requires substantial distortion of the arteries but may be more versatile for disease that extends farther down the PFA.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of patchless proximal profundoplasty and common femoral endarterectomy

Tse

Kapila

2023

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Background: Typical repair of common femoral artery (CFA) occlusive disease involves surgical endarterectomy followed by patch closure; however, prosthetic materials may become infected. In addition, in our institution, we have experienced an increased incidence of severe patch-related restenosis. We describe a technique for CFA endarterectomy and patchless proximal profundoplasty, and evaluate its feasibility. Methods: We performed a single-centre retrospective cohort study of patients who, between July 1, 2020, and June 30, 2021, underwent a procedure that consisted of transection of the superficial femoral artery (SFA) off the femoral bifurcation in a bevelled manner, eversion endarterectomy of the SFA, remote-type endarterectomy of the CFA, direct visualization of the end point in the profunda femoris artery (PFA) with a longitudinal arteriotomy extension if needed and reimplantation of the SFA “hood” as a patch. We collected clinical information and outcomes from the patients’ charts. Results: Ten patients who underwent a patchless profundoplasty procedure during the study period were identified. Indications for repair included tissue loss (3 patients), rest pain (2 patients), claudication (3 patients) and establishing access for other procedures (2 patients). Profunda femoris artery arteriotomy extensions were used in 5 cases. Six cases included simultaneous iliac or infrainguinal revascularization. All cases were technically successful. There was 1 intraoperative complication of remote tibial balloon angioplasty tear. The mean follow-up time was 199 (range 29–381) days. There were no surgical site infections. All patients were asymptomatic, with patent CFAs, at last follow-up. There was 1 case of surgical site restenosis and 1 reintervention for remote stenosis. The average increase in ankle and toe brachial indices was 44% and 75%, respectively. One patient was readmitted for gastrointestinal bleeding. One patient died from an acute myocardial infarction, on postoperative day 34. Conclusion: The patchless profundoplasty technique is feasible and results in autologous anatomic repair of CFA disease without the need for vein, and allows direct visualization and tacking sutures of the proximal PFA. This technique may replace the ubiquitous vascular procedure of patch arterioplasty of the CFA, depending on the anatomic configuration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Feasibility of patchless proximal profundoplasty and common femoral endarterectomy

Tse

Kapila

2023

cjs

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“…7 Although it remains a valuable solution for the carotid bifurcation, 8,9 this technique is now less frequently used in the iliofemoral territory, with a few authors reporting their results. 10,11 The aim of this study is to present our experience implementing the eversion femoral endarterectomy technique in selected cases of common femoral occlusive disease.…”

Section: Introductionmentioning

confidence: 99%

A single-center experience in the eversion femoral endarterectomy

et al. 2020

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Objectives Endarterectomy is the treatment of choice for arterial occlusive disease of the femoral bifurcation. Longitudinal arteriotomy and prosthetic patch angioplasty is the standard technique but, due to the increasing concerns with prosthetic-related infections and multidrug-resistant pathogens our group adopted an alternative approach. We present our experience with eversion femoral endarterectomy. Methods All patients submitted to eversion femoral endarterectomy in a single institution during 2016–2019 were retrospectively analyzed. Patient demographics, surgical data, and complications were captured from medical records. Results Nineteen patients, 84.2% male and a median age of 67 years (IQR 62–78) were submitted to eversion femoral endarterectomy with a median follow-up of 180 days (IQR 71–395). Seventeen (89.4%) patients were treated for chronic limb ischemia and the other two were submitted to femoral endarterectomy during endovascular aortic aneurysm repair. Most of the patients had smoking history (84.2%), followed by hypertension (68.4%), dyslipidemia (63.2%), coronary heart disease (29.4%), and diabetes (26.3%). Only 3 patients (15.8%) were submitted exclusively to endarterectomy, 13 (68.4%) were submitted to endarterectomy as an adjuvant for peripheral endovascular treatment, 2 (10.5%) as a concomitant procedure to endovascular repair of aortic aneurysm, and 1 (5.3%) was complemented with thrombectomy of the femoro-popliteal sector. Primary patency rates were 100% and 87.5% (CI (38.7–98.1)) at 6 and 12 months, respectively. Primary-assisted and secondary patency rates were 100%. The 30-day mortality rate was 5.3% ( n = 1) and complication rate 10.5% ( n = 2). One patient complicated with acute renal disease related to rhabdomyolysis. Another patient developed a wound-related hematoma treated with surgical drainage, but died three days after consequent to ischemia-reperfusion injury. Conclusions Eversion femoral endarterectomy is a safe and feasible technique, with good patency results and respecting the concept of leaving nothing behind. A careful control of the proximal and distal endpoints is essential for the success of the technique.

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Experience with Eversion Endarterectomy of the Common Femoral Artery with Comparison to Standard Endarterectomy with Patch

Mirmehdi

Rigamer

Nguyen

et al. 2020

Annals of Vascular Surgery

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Eversion Femoral Endarterectomy for Iliofemoral Occlusive Disease: A Description of Technique and Series of Cases

Cited by 9 publications

References 12 publications

Feasibility of patchless proximal profundoplasty and common femoral endarterectomy

Feasibility of patchless proximal profundoplasty and common femoral endarterectomy

A single-center experience in the eversion femoral endarterectomy

Experience with Eversion Endarterectomy of the Common Femoral Artery with Comparison to Standard Endarterectomy with Patch

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