Abstract
Background
Objective: Remote Superficial Femoral Artery Endarterectomy (RSFAE) is a hybrid procedure
with low risk for peri-operative complications and promising patency rates over time.
The aim of this study was to summarize current literature and to determine the role
of RSFAE in limb salvage with regards to technical success, limitations, patency rates
and long-term outcomes.
Methods
This systematic review and meta-analysis was performed according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results
Overall 19 studies were identified, comprising 1,200 patients with extensive femoropopliteal
disease among whom 40% presented with chronic limb threatening ischemia. The average
technical success rate was 96%, with a 7% rate for peri-operative distal embolization
and 13% rate for SFA perforation. The primary patency was 64% and 56%, primary assisted
patency was 82% and 77% and secondary patency was 89% and 72% at 12 and 24 months
follow up respectively.
Conclusion
For long femoropopliteal TASC C/D lesions, RSFAE appears to be a minimally invasive
hybrid procedure with acceptable perioperative morbidity, low mortality, and acceptable
patency rates. RSFAE should be considered an alternative to open surgery or a bridge
to bypass procedure.
Keywords
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References
- Clinical practice. Intermittent claudication.The New England journal of medicine. 2007; 356 (2007/03/23): 1241-1250https://doi.org/10.1056/NEJMcp064483
- Endovascular management as first therapy for chronic total occlusion of the lower extremity arteries: comparison of balloon angioplasty, stenting, and directional atherectomy.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2011; 18 (2011/10/14): 624-637https://doi.org/10.1583/11-3539.1
- One-Year Results of the LIBERTY 360 Study: Evaluation of Acute and Midterm Clinical Outcomes of Peripheral Endovascular Device Interventions.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2019; 26 (2019/02/07): 143-154https://doi.org/10.1177/1526602819827295
- Preventing Major Amputations in Patients with Critical Limb Ischemia.Curr Cardiol Rep. 2018; 20 (74. 2018/07/12)https://doi.org/10.1007/s11886-018-1019-2
- National trends in lower extremity bypass surgery, endovascular interventions, and major amputations.J Vasc Surg. 2009; 50 (2009/06/02): 54-60https://doi.org/10.1016/j.jvs.2009.01.035
- 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary.Vasc Med. 2017; 22 (2017/05/13): NP1-NP43https://doi.org/10.1177/1358863X17701592
- Comparative Effectiveness of Plain Balloon Angioplasty, Bare Metal Stents, Drug-Coated Balloons, and Drug-Eluting Stents for the Treatment of Infrapopliteal Artery Disease: Systematic Review and Bayesian Network Meta-analysis of Randomized Controlled Trials.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2016; 23 (2016/10/07): 851-863https://doi.org/10.1177/1526602816671740
- Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery.The New England journal of medicine. 2006; 354 (2006/05/05): 1879-1888https://doi.org/10.1056/NEJMoa051303
- Association between health status and long-term mortality after percutaneous revascularization of peripheral artery disease.Catheter Cardiovasc Interv. 2016; 87 (2016/02/20): 1149-1155https://doi.org/10.1002/ccd.26442
- Anatomic runoff score predicts cardiovascular outcomes in patients with lower extremity peripheral artery disease undergoing revascularization.Am Heart J. 2015; 170 (2015/08/25): 400-408https://doi.org/10.1016/j.ahj.2015.04.026
- Endovascular intervention for peripheral artery disease.Circ Res. 2015; 116 (2015/04/25): 1599-1613https://doi.org/10.1161/circresaha.116.303503
- The tibiopedal retrograde vascular access for challenging popliteal and below-the-knee chronic total occlusions: literature review and description of the technique.The Journal of cardiovascular surgery. 2017; 58 (2017/02/17): 371-382https://doi.org/10.23736/s0021-9509.17.09905-0
- Extreme below-the-knee interventions: retrograde transmetatarsal or transplantar arch access for foot salvage in challenging cases of critical limb ischemia.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2012; 19 (2012/12/06): 805-811https://doi.org/10.1583/jevt-12-3998r.1
- Retrograde approach for complex popliteal and tibioperoneal occlusions.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2008; 15 (2008/10/09): 594-604https://doi.org/10.1583/08-2440.1
- The BEST-CLI trial: a multidisciplinary effort to assess which therapy is best for patients with critical limb ischemia.Tech Vasc Interv Radiol. 2014; 17 (2014/09/23): 221-224https://doi.org/10.1053/j.tvir.2014.08.012
- Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia.New England Journal of Medicine. 2022; https://doi.org/10.1056/NEJMoa2207899
- Retrograde popliteal access as bail-out strategy for challenging occlusions of the superficial femoral artery: a multicenter registry.Catheter Cardiovasc Interv. 2012; 79 (2012/01/12): 1188-1193https://doi.org/10.1002/ccd.23361
- Devices for infrainguinal endovascular therapy: menu a la carte or table d'hote?.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2011; 18 (2011/10/14): 638-641https://doi.org/10.1583/11-3539c.1
- 2-Year Results of Paclitaxel-Coated Balloons for Long Femoropopliteal Artery Disease: Evidence From the SFA-Long Study.JACC Cardiovasc Interv. 2017; 10 (2017/04/08): 728-734https://doi.org/10.1016/j.jcin.2017.01.028
- Supera self-expanding stents for endovascular treatment of femoropopliteal disease: a review of the clinical evidence.Vasc Health Risk Manag. 2015; 11 (2015/07/24.): 387-395https://doi.org/10.2147/vhrm.S70229
- Remote superficial femoral artery endarterectomy: early results for TASC D lesions in patients with severe ischemia.Vasc Endovascular Surg. 2007; 41 (2007/08/21): 310-315https://doi.org/10.1177/1538574407302751
- Randomized controlled trial of remote endarterectomy versus endovascular intervention for TransAtlantic Inter-Society Consensus II D femoropopliteal lesions.J Vasc Surg. 2012; 56 (2012/10/10): 1598-1605https://doi.org/10.1016/j.jvs.2012.06.081
- Remote superficial femoral artery endarterectomy and distal aSpire stenting: results of a multinational study at three-year follow-up.The Journal of cardiovascular surgery. 2006; 47 (2006/09/06): 385-391
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.PLoS Med. 2009; 6 (2009/07/22)e1000100https://doi.org/10.1371/journal.pmed.1000100
- Measuring inconsistency in meta-analyses.Bmj. 2003; 327 (2003/09/06): 557-560https://doi.org/10.1136/bmj.327.7414.557
- Endovascular Intervention for the Treatment of Trans-Atlantic Inter-Society Consensus (TASC) D Femoropopliteal Lesions: A Systematic Review and Meta-Analysis.Cardiovasc Revasc Med. 2021; 22 (2020/06/22): 52-65https://doi.org/10.1016/j.carrev.2020.06.014
- A prospective randomized trial on endovascular recanalization with stenting versus remote endarterectomy for the superficial femoral artery total occlusive lesions.J Vasc Surg. 2022; 76 (2022/03/02): 158-164https://doi.org/10.1016/j.jvs.2022.02.019
- Remote endarterectomy versus supragenicular bypass surgery for long occlusions of the superficial femoral artery: medium-term results of a randomized controlled trial (the REVAS trial).Ann Vasc Surg. 2010; 24 (2010/11/03): 1015-1023https://doi.org/10.1016/j.avsg.2010.03.022
- Remote Endarterectomy and Lamina Vastoadductoria Dissection Improves Superficial Femoral Artery Biomechanical Behavior during Limb Flexion.Annals of Vascular Surgery. 2018; 50: 112-118https://doi.org/10.1016/j.avsg.2017.12.007
- Guided remote endarterectomy for superficial femoral artery occlusions: a technical note.Int Angiol. 2009; 28 (2009/11/26): 380-384
Vijaykumar K TY, Kum S and Tang TY. Remote Endarterectomy for an Occluded Superficial Femoral Artery (SFA) Stent– a Hybrid Technique for the SFA Intervention Toolbox. Surgical Case Reports. DOI: 10.31487/j.SCR.2019.02.016.
- Remote endarterectomy to remove infected Viabahn stent-graft.J Vasc Surg Cases Innov Tech. 2021; 7 (2021/07/20): 474-477https://doi.org/10.1016/j.jvscit.2021.04.020
- Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia.Vasc Med. 2021; 26 (2021/02/16): 210-224https://doi.org/10.1177/1358863x20987612
Article info
Publication history
Accepted:
February 20,
2023
Received in revised form:
February 19,
2023
Received:
December 6,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
