Aneurysmal degeneration of the superficial femoral artery after remote endarterectomy

[Results of loop endarterectomy and femoropopliteal bypass grafting in TASC C and D lesions]

AIM

The aim of our investigation was to analyse the results of treatment of patients with atherosclerotic lesions of the femoropopliteal segment by means of femoropopliteal bypass grafting or loop endarterectomy within the framework of a single-centre retrospective study.

PATIENTS AND METHODS

The study included a total of 177 patients who were divided into two groups. Group One was composed of 108 patients subjected to loop endarterectomy from the arteries of the femoropopliteal segment, and Group Two comprised 69 patients who endured femoropopliteal bypass surgery using a synthetic graft.

RESULTS

Thoroughly analysed were the clinical, demographic, anatomical and perioperative data, as well as intra- and perioperative complications, followed by assessment of primary and secondary patency, with no statistically significant differences in these parameters revealed. Secondary patency was somewhat better in the group of loop endarterectomy. Also determined and examined were specific complications such as insufficient extraction of the plaque, perforation of the artery with the loop, thinning of the wall, detachment of the calcified plaque. This is followed by discussing variants of correction of similar events. In the group of loop endarterectomy, there were no severe complications, such as myocardial infarction, stroke, amputation in the early postoperative period.

CONCLUSION

Loop endarterectomy is an acceptable alternative to femoropopliteal bypass grafting with a synthetic prosthesis. Taking into account all specific complications, it is possible to achieve minimization of unsuccessful outcomes.

[Efficacy of using loop endarterectomy]

Endarterectomy is considered to be the most physiological technique of correcting arterial blood flow, since it does not require implantation of a synthetic material, with blood flow restored through its own bed. However, surgeons have long sought to work out the most effective modification of endarterectomy, which eventually resulted in creation of a method known as loop endarterectomy. Mention should be made that some researchers report patency which may be comparable to that of autovenous bypass grafting, while others report negative results of using loop endarterectomy. Such ambiguous findings have impelled the authors to carry out a scrupulous study of the data available in scientific literature. The presented review discusses advantages and shortcomings of loop endarterectomy, also analysing possible complications in loop endarterectomy (causes, probability of occurrence, etc.). Also discussed herein is the problem concerning a combination of loop endarterectomy and roentgen-endovascular stenting.