Remote SFA Endarterectomy

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Presentation transcript:

Remote SFA Endarterectomy How I Do It David Rosenthal, MD

SFA (> 20 cm) PTA Stent LA Atherectomy

“REMOTE” SFA ENDARTERECTOMY Performed through small incision “Debulked” arterial plaque Endovascular stent Durable SFA procedure?

Fogarty Endohelix MollRing Cutter Vollmar Stripper Martin Dissector

BALLOON STENT ANGIOPLASTY “TACK” DISTAL PLAQUE

aSpire Stent Non-flexible Stent aSpire Stent

PURPOSE Retrospective, multicenter study was to examine the medium-term results of remote superficial femoral artery endarterectomy (RSFAE) and distal aSpire stenting.

STUDY GROUP (n=235) Indications for procedure: Claudication in 188 Limb Salvage in 47 All patients underwent serial duplex color-flow ultrasound scanning during follow-up. RISK FACTORS Percent (%)

RESULTS One death Wound complications in 2% Mean length of endarterectomized SFA=28.2cm Mean hospital LOS 1.3 days

RESTENOSIS (n=24) . Nine over course SFA Eight at adductor canal Seven at distal stent Intimal hyperplasia ? . = 9%

LONG SEGMENT SFA NOT SUCCESSFULLY TREATED Small caliber artery Disease long & diffuse Tortuous Low Flow Compression forces

DEBULKING SFA Increase diameter Reduce recoil & remodeling Preserving collaterals Durable procedure

CONCLUSION CONCLUSION If RSFAE and distal aSpire stenting long-term patency rates similar to AKFP, it may prove to be minimally invasive durable adjunct for treatment of SFA occlusive disease.