Eversion Endarterectomy of the Femoral Bifurcation: Technique, Results and Potential Advantages

Esposito, Andrea; Menna, Danilo; Baiano, A.; Benedetto, Pietro; Leo, Ferdinando Di; Cappiello, Antonino Pierluigi

doi:10.1016/j.avsg.2019.12.004

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…4 This technique is associated with high technical success and acceptable early-term clinical and hemodynamic improvement. 2 Additionally, Henretta et al described a combined technique involving balloon-assisted remote endarterectomy of the EIA with a ring dissector advanced remotely from the proximal endarterectomized CFA to the proximal edge of the diseased EIA over an balloon earlier positioned and inflated at site; accordingly, the balloon is briefly deflated, repositioned within the ring dissector and reinflated within the latter, cutting the proximal end of the plaque and allowing removal of the endarterectomized core plaque by retracting of both the inflated balloon and the cutter. 6 In cases of completely occluded EIA, the access across the occluded vessel is achieved though the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

“…Femoral endarterectomy remains the gold standard in the treatment of atherosclerotic lesions of the femoral bifurcation presenting low perioperative mortality <2% and excellent long-term patency rates, while the use of vein patches for arterioplasty reduces significantly the infection rates and avoids surgical complications. 2 It can be performed with direct suture, patch angioplasty or with the eversion technique. 3 Femoral eversion endarterectomy is not easy or feasible in all patients; the presence of double profunda femoral artery or its early bifurcation along with multiple collaterals of great diameter hampers its applicability.…”

Section: Discussionmentioning

confidence: 99%

“…As repeatedly mentioned in the literature, though the current TransAtlantic Inter-Society Consensus (TASC) guidelines recommend open surgical therapy for such Type-C lesions, this approach is neither easy nor represents the current real-life practice. [1][2][3][4] The combined, hybrid iliofemoral endarterectomy with iliac stenting has been reported in the past as an effective treatment mode. [2][3][4][5][6][7][8] Several practices have been suggested accordingly, combining a eversion femoral endarterectomy extending to the level past the inferior epigastric artery and inguinal ligament with an iliac angioplasty performed over a guidewire crossing the iliac lesion either retrogradely or in a cross-over manner and retrieved through a femoral sheath or an open femoral arteriotomy.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] The combined, hybrid iliofemoral endarterectomy with iliac stenting has been reported in the past as an effective treatment mode. [2][3][4][5][6][7][8] Several practices have been suggested accordingly, combining a eversion femoral endarterectomy extending to the level past the inferior epigastric artery and inguinal ligament with an iliac angioplasty performed over a guidewire crossing the iliac lesion either retrogradely or in a cross-over manner and retrieved through a femoral sheath or an open femoral arteriotomy. 3,7,8 Additionally, a remote balloon-assisted mollring iliac endarterectomy followed by femoral endarterectomy and iliac stenting has been also described.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tips and Tricks to Facilitate the Combined Iliofemoral Endarterectomy With Stenting for Heavily Calcified Common Femoral Artery Atherosclerosis With Involvement of the External Iliac Artery

Georgakarakos,

Dimitriadis,

Parisidis

et al. 2023

Vasc Endovascular Surg

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Background Management of a heavily calcified atherosclerotic occlusive disease involving the common femoral artery (CFA) and external iliac artery (EIA), poses a surgical challenge. Though the current guidelines recommend open surgical therapy for such lesions, this approach is neither easy nor represents the current real-life practice. Purpose To describe tips and tricks facilitating the hybrid technique for the management of distal iliofemoral atherosclerotic disease, where classic endarterectomy is inadequate or ill-performed. Technique A contralateraly inserted guidewire reaches the distal iliac artery via the crossover technique and is directly retrieved from the femoral arteriotomy immediately after removal of the anterior plaque segment. The retrieved and secured guidewire enables extensive retrograde CFA endarterectomy over the wire with avusion proximally to the inguinal ligement, followed by patch arterioplasty. Externalizing the guidewire from the patch enables traction on it and facilitates advancement of the stent through tortuous or stenosed iliac vessels as well as accurate stent deployment to cover the margin of the EIA residual plaque. Moreover, this manipulation enables ipsilateral placement of a sheath and passage of a second, retrograde guidewire to perform kissing stenting in the common iliac vessels. Chronic thrombotic lesions require covered stents to avoid thrombus propagation and meticulous flushing before completion of the femoral patching. Conclusions The combined iliofemoral endarterectomy with stenting does not require advanced endovascular skills and prevents complications associated with incomplete femoral endarterectomy. Extensive avulsion endarterectomy proximal to the inguinal ligament is efficiently and safely performed over a retrieved crossover guidewire, enabling precise residual stenting above the flexion site.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%