Abstract
Endovascular surgical procedures have become an integral part of the treatment of arterial occlusive disease in the femoropopliteal segment—an adjunct to conventional peripheral arterial reconstructions.1–3 Additionally, new percutaneous arterial disobliteration devices have been designed. Catheter-based therapies such as percutaneous transluminal balloon angioplasty (PTA) have been effective for short and solitary lesions in the femoropopliteal segment. However, the long-term patency results of PTA or laser-assisted balloon angioplasty are discouraging for long (more than 10 cm) occlusive lesions.4–7 The use of stents in the femoropopliteal artery in combination with angioplasty has not truly altered these results despite close surveillance and reintervention.8–10 Alternative techniques to recanalize chronic occlusions of the superficial femoral artery are based on plaque removal rather than stretching and remodeling the arterial wall. These methods can be divided into two categories: “going through” and “going around” the occlusion. Common to both methods is the ability to remove the occlusive atheroma using a mechanical atherectomy device or performing endarterectomy. Atherectomy devices were developed to improve the results of lesions that were unfavorable for PTA and to decrease the incidence of acute arterial thrombosis. Transluminal endarterectomy has a history of more than 50 years, the first case being reported in 1947 by the Portugese surgeon J. Cid Dos Santos.11,12 Also, endarterectomy has shown far better long-term patency results than PTA for long lesions because of a high incidence of recurrent stenoses after balloon angioplasty that require repeated intervention.13
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References
Ahn SS: Endovascular surgery: current concepts and its importance to the vascular surgeon, Eur J Vasc Surg 6: 1–3. 1992.
Bergquist D, Karacagil S: Femoral artery disease, Lancet 343: 773–778, 1994.
Inahara T, Scott CM: Endarterectomy for segmental occlusive disease of the superficial femoral artery, Arch Surg 116: 1547–1553, 1981.
Becquemin J-P, Cavillon A, Haiduc F: Surgical transluminal femoropopliteal angioplasty: multivariate analysis outcome, J Vasc Surg 19: 495–502, 1994.
Capek P, McLean GK, Berkowitz HD: Femoropopliteal angioplasty: factors influencing long-term success, Circulation 83 (suppl I): 70–80, 1991.
Isner JM, Rosenfield K: Redefining the treatment of peripheral artery disease: role of percutaneous revascularisation, Circulation 88: 1534–1557, 1993.
Johnston KW: Femoral and popliteal arteries: reanalysis of results of balloon angioplasty, Radiology 183: 767–771, 1992.
Vroegindeweij D, Vos LD, Tielbeek AV et al: Balloon angioplasty combined with primary stenting versus balloon angioplasty alone in femoropopliteal obstructions: a comparative randomized study, Cardiovasc Intervent Radiol 20: 420–425, 1997.
Do DD, Triller J, Walpoth BH et al: A comparison study of self expandable stents vs balloon angioplasty alone in femoropopliteal artery occlusions, Cardiovasc Intervent Radiol 15: 306–312, 1992.
Gray BH, Sullivan TM, Childs MB et al: High incidence of restenosis/reocclusion of stents in the percutaneous treatment of long-segment superficial femoral artery disease after suboptimal angioplasty, J Vasc Surg 25: 74–83, 1997.
Dos Santos JC: Sur la desobstruction des thromboses arterielles anciennes, Mem Acad Chir 73: 409–411, 1947.
Dos Santos JC: Leriche memorial lecture: from embolectomy to endarterectomy or the fall of a myth, J Cardiovasc Surg 17: 113–128, 1976.
Vroegindeweij D, Idu MM, Buth J et al: The cost-effectiveness of treatment of short occlusive lesions in the femoropopliteal artery: balloon angioplasty versus endarterectomy, Eur J Vasc Endovasc Surg 10: 40–50, 1995.
Holfing B, Polnitz AV, Backa D et al: Percutaneous removal of atheromatous plaques in peripheral arteries, Lancet 1: 384–386, 1988.
Johnson DE, Selmon MR, Simpson JB: Primary stenoses and restenoses excised by peripheral atherectomy: a histologic study, J Am Coll Cardiol 11: 173A, 1988.
Snyder SO Jr, Wheeler JR, Gregory RT et al: The Trac-Wright atherectomy device. In Ahn SS, Moore WS, editors: Endovascular surgery, ed 2, Philadelphia, 1992, Saunders, pp 287–294.
Ahn SS, Eton D, Yeatman LR et al: Intraoperative peripheral rotary atherectomy: early and late clinical results, Ann Vasc Surg 6: 272–280, 1992.
Fogarty TJ, Biswas A, Hermann GD et al: Atherectomy: a review of current devices and methods. In Kerstein MD, White JV, editors: Alternatives to open vascular surgery, Philadelphia, 1995, Lippincott, pp 247–264.
Collaborative Rotablator Atherectomy Group (CRAG): Peripheral atherectomy with the rotablator: a multicenter report, J Vasc Surg 19: 509–515, 1994.
Cannon JA, Barker WF: Successful management of obstructive femoral arteriosclerosis by endartectomy: experience with a semiclosed technique in selected cases, Surgery 38: 48–59, 1955.
Cannon JA, Barker WF, Kawakami IG: Femoral popliteal endarterectomy in the treatment of obliterative atherosclerotic disease, Surgery 43: 76–93, 1958.
Vollmar J: Rekonstruktive Chirurgie derArterien, Stuttgart, 1967, Georg Thieme Verlag.
Darling RC, Linton RR: Durability of femoropopliteal reconstructions, Am J Surg 123: 472–479, 1972.
DeWeese JA, Barner HB, Mahoney EB et al: Autogenous venous bypass grafts and thromboendarterectomies for atherosclerotic lesions of the femoropopliteal arteries, Ann Surg 163: 205–214, 1966.
Van der Heijden FHWM, Eikelboom BC, van Reedt Dortland RWH et al: Long-term results of semi-closed endarterectomy of the superficial femoral artery and the outcome of failed reconstruction, J Vasc Surg 18: 271–279, 1993.
Imparato AM, Bracco A, Kim GE: Comparison of three technics for femoral-popliteal arterial reconstruction, Ann Surg 177: 375–380, 1973.
Mukherjee D, Inahara T: Endarterectomy as the procedure of choice for atherosclerotic occlusive lesions of the common femoral artery, Am J Surg 157: 498–500, 1989.
Vercellio G, Castelli P, Coletti M et al: Semiclosed thromboendarterectomy on femoropopliteal-tract revisited after fourteen years experience on 595 cases, Int Surg 71: 59–61, 1986.
Walker PM, Imparato AM, Riles TS et al: Longterm results in superficial femoral artery endarterectomy, Surgery 89: 23–30, 1981.
Ouriel K, Smith CR, DeWeese JA: Endarterectomy for localized lesions of the superficial femoral artery at the adductor canal, J Vasc Surg 3: 531–534, 1986.
Kouchoukos NT, Levy JF, Balfour MD et al: Operative therapy for femoral-popliteal arterial occlusive disease, Circulation 35 (suppl I): 174–182, 1967.
Abbott WM, Green RM, Matsomoto T et al: Prosthetic above-knee femoropopliteal bypasss grafting: results of a multicenter randomized prospective trial, J Vasc Surg 25: 19–28, 1997.
Van der Heijden FHWM, Legemate DA, van Leeuwen MS et al: Duplex scanning, ankle/brachial index and clinical symptoms to detect restenosis in the superficial femoral artery after endarterectomy, Thesis, Universiteit Utrecht, 1994.
Taylor PR, Wolfe JHN, Tyrrell MR et al: Graft stenosis: justification for 1-year surveillance, Br J Surg 77: 1125–1128, 1990.
Brücke, Lechner G, Piza F et al: Ursachen von früh-und spätverschlüssen nach Thromboendarteriektomie und Venenrekonstruktion im femoro-poplitealen Abschnitt, Vasa 2: 24–27, 1973.
Idu MM, Blankenstein JD, de Gier P et al: Impact of a color-flow duplex surveillance program on infrainguinal vein graft patency: a five-year experience, J Vasc Surg 17: 42–53, 1993.
Ho GH, Moll FL, Hedeman Joosten PPA et al: The Mollring Cutter remote endarterectomy: preliminary experience with a new endovascular technique for treatment of occlusive superficial femoral artery disease, J Endovasc Surg 2: 278–287, 1995.
Cragg AH, Drake MD: Percutaneous femoropopliteal graft placement, Radiology 187: 643–648, 1993.
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Ho, G.H., Moll, F.L. (1999). Disobliteration Techniques. In: White, R.A., Fogarty, T.J. (eds) Peripheral Endovascular Interventions. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3105-7_20
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DOI: https://doi.org/10.1007/978-1-4757-3105-7_20
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