Superficial femoral artery eversion endarterectomy: a useful adjunct for infrainguinal bypass in the presence of limited autogenous vein.

Abstract

To evaluate, in a group of technically high-risk patients, the results of infrainguinal revascularization using a conduit constructed with endarterectomized superficial femoral artery (SFA) and available arm or saphenous vein. Of 237 consecutive lower extremity vein graft bypass procedures performed in 195 patients from July 1992 through August 1996, 15 SFA eversion endarterectomies (in 10 men and five women; median age, 70 years) were performed and used as a composite bypass conduit with available autogenous vein for the treatment of limb-threatening ischemia. In each case, an occluded SFA was divided 8 to 15 cm distal to its origin, proximally endarterectomized, and sewn end-to-end to a segment of vein to provide adequate conduit length for bypass grafting. Indications for this technique were unavailability of vein as a result of failed previous bypass grafting (n = 10) or previous coronary artery bypass grafting (n = 5). Veins were sewn distally to a below-knee popliteal artery (n = 4; 27%) or tibial artery (n = 11; 73%). Primary patency, secondary patency, and limb salvage rates at 36 months by life table analyses for the 237 grafts were 62.3%, 81.0%, and 77.2%, respectively. The 15 composite SFA-vein bypass grafts had 36-month primary patency, secondary patency, and limb salvage rates of 60.0%, 72.0%, and 65.9%, respectively (mean follow-up, 15 months). Currently, eight of these patients (53%) have patent bypass grafts; two (13%) died at 4 and 18 months after the operation with patent grafts; two (13%) underwent amputations for progressive foot gangrene despite a patent bypass graft; and three (20%) had grafts that thrombosed at 4, 5, and 10 months. Typical hyperplastic intrinsic graft-threatening stenoses developed in two patients (13%) in the SFA segment at 4 and 8 months; they were discovered by routine duplex scan surveillance. Composite SFA eversion endarterectomy/vein graft conduits yield acceptable results, behave similarly to other autogenous conduits used for technically high-risk infrainguinal revascularization, and are beneficial when autogenous vein is limited.