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 endarterectomy 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.