Endoluminal femoropopliteal bypass for intermittent claudication

Abstract

Objectives: (i) to describe our initial clinical experience with endoluminal femoropopliteal bypass using a technique developed in a cadaveric model; (ii) to identify areas requiring technical modification to improve patency and complication rates. Design: prospective, experimental pilot study. Materials and methods: fourteen consecutive patients with disabling intermittent claudication and superficial femoral artery occlusion underwent endarterectomy through a groin incision and endoluminal placement of a polytetrafluoroethylene graft. Follow-up was by duplex ultrasound and arteriography. Results: two endovascular technical failures required conversion to open surgery. The cumulative primary (1°), 1°-assisted and secondary (2°) patency rates at 1 year were 35.7%, 42.8% and 71.4% respectively; at 2 years the patency rates were 14.3%, 31.2% and 57.1%. Twenty-three endovascular interventions were required to maintain graft patency in 10 patients. Five patients subsequently required conventional bypass, of whom two proceeded to major amputation because of graft infection. Seven endovascular grafts remain patent at a mean follow-up of 50 months. Conclusions: this minimally invasive surgical technique is feasible, with acceptable patency rates. However, considerable investment of time and resources is required to maintain graft patency. With increasing experience and improved technical design, this procedure may offer a real alternative to conventional surgery in patients disabled by short-distance claudication.