The importance of revision of early restenosis after endovascular remote endarterectomy in SFA occlusive disease.

OBJECTIVES

to investigate the results of revision of recurrent stenoses after superficial femoral artery (SFA) remote endarterectomy.

DESIGN

prospective, non-open, study.

MATERIALS: eighty-eight consecutive patients with long segmental SFA occlusive disease underwent 101 remote end-arterectomy procedures. All patients had chronic lower extremity ischaemia necessitating surgical intervention.

METHODS

clinical, haemodynamic, and duplex examinations were performed postoperatively at regular intervals, identifying 46 recurrent stenosed (PSV ratio >2.5) limbs, which formed the cohort for this study. The median follow-up was 25 months. Secondary revision was performed in 23 limbs, based on recurrent symptoms and individual preference of the attending vascular surgeon. Cumulative primary and primary assisted-patency rates were compared using the log-rank test of significance.

RESULTS

univariate analysis did not show any significant differences for other demographic and lesion characteristics apart from recurrent symptoms (all revised). Multivariate analysis revealed that revision "adjusted for time-of-onset" predicted reocclusion (p=0.007; HR 0. 21; 95% CI 0.06, 0.66). Among subjects in whom restenoses developed within 1 year, revision of recurrent stenoses improved primary patency rates from 47% to 77% at 30 months.

CONCLUSIONS

revision of early (<1 year) recurrent stenoses improves the mid-term patency rates of SFA remote endarterectomy.