TITLE:
Hybrid Procedure Utilizing Stent Grafts to Stabilize Distal Flaps after Common and Superficial Femoral Endarterectomy
AUTHORS:
David V. Pham, Bogdan Protyniak, Samuel Hui, Ryan N. Cappa, George Constantinopoulos
KEYWORDS:
Common Femoral Endarterectomy, Superficial Femoral Endarterectomy, Stent Graft, Distal Flap, Vollmar Ring Dissector, Viabahn Stent
JOURNAL NAME:
Surgical Science,
Vol.6 No.3,
March
9,
2015
ABSTRACT:
Background: Endarterectomy has long
been the standard for common femoral artery (CFA) occlusive disease. Hybrid
procedures utilizing endovascular and open techniques have recently been used
for revascularization. The purpose of this study was to evaluate the
effectiveness of the use of a stent graft to stabilize the distal flap and
prevent further dissection after extensive endarterectomy. Methods: All
patients from Monmouth Medical Center in Long Branch, NJ from September 2008 to
March 2013 who underwent an extensive common and superficial femoral (SFA)
endarterectomy combined with the use of a Viabahn (Gore Medical) stent graft to
stabilize the distal flap were included in the study. These stents were
deployed in the proximal SFA after extensive endarterectomy, under direct
visualization, without the aid of fluoroscopy. Due to the location in the SFA,
these flaps were not amenable to suture tacking. Results: Fifteen patients met
these criteria and were included in our study. Twelve patients underwent
femoral endarterectomy for severe claudication and three patients for limb
salvage. Technical success was achieved in all 15 patients. Five patients also
had stents placed proximally to increase inflow and one patient had an
additional stent placed distally to improve outflow. There were no
intraoperative or postoperative complications. Conclusion: Stent graft
placement allows a more extensive endarterectomy to be performed by stabilizing
the distal flap allowing a safe transition into the true lumen that is not
possible with suture tacking.