Superficial Femoral Endarterectomy with Intraarterial PTFE Grafting

Abstract

Purpose: To report early experience with a new endovascular approach to treating occluded Wallstents™ in the superficial femoral artery (SFA). Methods and Results: A symptomatic female patient with a 20-cm SFA occlusion involving a 10-cm Wallstent placed 2 years previously was offered an endovascular intervention. However, when percutaneous recanalization techniques failed, a semiclosed endarterectomy was undertaken using a conventional ring stripper. Although the atherosclerotic core and stent were removed smoothly, a small perforation was seen in the distal SFA. To avoid surgical repair, the endarterectomized segment was lined endoluminally using a 3-mm diameter, thin-walled polytetrafluoroethylene graft. A 15-mm Palmaz stent was used for distal fixation, with a plasty procedure performed at the proximal arteriotomy. There were no postoperative complications, and the patient, who was discharged on the second day, remains asymptomatic with normal flow through the graft at 3 months. Conclusion: Newer endovascular techniques may be applied in concert with conventional semiclosed endarterectomy to successfully treat lengthy SFA occlusions, particularly those involving stents.