Remote endarterectomy

Saaya S, et al. A prospective randomized trial on endovascular recanalization with stenting vs. remote endarterectomy for the superficial femoral artery total occlusive lesions. J Vasc Surg. 2022 Feb 26:S0741-5214(22)00380-9. Full-text for Emory users.

Key Findings: In patients with superficial femoral artery total occlusive lesions of size greater than 250 mm, the 1-year and 4-year cumulative primary patencies of stenting (EI) and remote endarterectomy (RE) were 83% vs 82% and 28% vs 46% (P = .04), respectively. Patencies of endovascular reintervention subgroups (65 patients in the EI subgroup and 32 patients in the RE subgroup) were 37% and 60% (P = .04), respectively.

Take Home Message: RE has a better 4-year primary patency compared with stenting in patients with superficial femoral artery total occlusive lesions of size greater than 250 mm. Endovascular reinterventions after RE showed a higher patency compared with reinterventions after EI.

Karathanos C, et al. Single-Center Experience With Remote Endarterectomy for the Treatment of Long-Segment Superficial Femoral Artery Occlusion: Long-Term Results. Vasc Endovascular Surg. 2015 Nov;49(8):250-5. Full-text for Emory users.

Results: Technical success rate was 100%. Immediate hemodynamic and clinical improvement were 92% and 75%, respectively. The mean increase in the Ankle-Brachial pressure index was 0.24. The primary, primary-assisted, and secondary patency rates were 50%, 83%, and 100%, respectively. The perioperative mortality rate was 8% (one death due to myocardial infarction). There was no early (30-day) reocclusion. During the follow-up, 5 (41.6%) cases underwent 7 reinterventions, all by endovascular means. The amputation rate was 16% (2 of 12).

Conclusions: The RE for long SFA occlusion is a feasible procedure with acceptable short- and long-term outcomes in the presence of distal arterial outflow. Good long-term patency and limb salvage can be achieved with close surveillance and with the compensation of endovascular reintervention procedures.

Martin JD, Hupp JA, Peeler MO, Warble PB. Remote endarterectomy: lessons learned after more than 100 cases. J Vasc Surg. 2006 Feb;43(2):320-6. Free full-text.

Results: Remote endarterectomy was the planned procedure in 133 patients. The mean age was 68 years, 68% were men, and 31% were diabetic. The indications for the procedure were claudication in 57% and limb salvage in 43%. In 16 patients (12%), technical issues precluded the completion of the remote endarterectomy and a bypass was performed. Successful retrograde iliac endarterectomy was performed in 7 patients, SFA endarterectomy in 105 patients, and combined retrograde iliac and antegrade SFA in 5 patients. The average duration of the procedure was 162 minutes +/- 69 minutes (SD). Half of the patients were discharged on the first postoperative day, and the average length of stay was 2.52 days. The mean follow-up was 19 months, with a primary patency of 70% at 30 months by life-table analysis. Limb salvage was 94%.

Conclusions: Remote endarterectomy is a viable and durable alternative to standard bypass procedures. It has equivalent patency to published results of bypass or endovascular procedures of the external iliac and superficial femoral arteries and may soon replace bypass as the preferred procedure for long-segment occlusions of these vessels.

Antoniou GA, et al. Remote endarterectomy for long segment superficial femoral artery occlusive disease. A systematic review. Eur J Vasc Endovasc Surg. 2008 Sep;36(3):310-8. Free full-text.

Results: Our search identified 19 retrospective or prospective case series; no randomized controlled trials comparing RSFAE with another treatment modality were identified. The average technical success rate was 94% and the procedure-related complication rate was 14.7%. The weighted mean cumulative primary patency rates were 60%, 57% and 35% at 1, 2 and 5 years, respectively. The weighted mean assisted primary patency rates were 75%, 77% and 50% at 1, 2 and 5 years, respectively. The weighted mean secondary patency rates were 88% and 62% at 1 and 2 years, respectively.

Conclusions: RSFAE has acceptable short-, medium- and long-term results but patients should undergo intensive surveillance postoperatively. Randomized controlled trials are needed to assess the durability of this procedure as compared to conventional open bypass surgery.

Figure 1. (a) The atherosclerotic core is dissected out of the arterial wall with a ring stripper. (b) The ring strip cutter transects the distal intimal core (arrow). (c) The whole intimal-atherosclerotic column has been removed. (d) A stent has been placed to cover the distal intimal flap (arrow).

More PubMed results on remote endarterectomy.

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