Open endarterectomy in short atherosclerotic occlusion of the popliteal artery

Abstract

The purpose of the study is to evaluate the results of open endarterectomy in short atherosclerotic occlusion of the popliteal artery. 47 patients (25 male and 22 female) underwent endarterectomy of the popliteal artery or popliteal artery and adjoining Superficial Femoral Artery (SFA) and tibio-peroneal bifurcation between January 2008 and December 2011. All patients underwent routine follow up at 1, 3, 6, and 12 months and yearly thereafter. Routine clinical examination, colour Doppler scan and if necessary, arteriogram were done to assess the outcome. The patients had a median age of 58 +/− 10.3 years. There was no difference in results between the limb side affected (left, n = 25, right, n = 22). The length of the lesion varied from 2 to 12 cm, and the largest endarterectomy done was 14 cm. The segments involved were popliteal artery alone in 32 (68.08 %) cases, popliteal artery with adjoining SFA in 5 (10.64 %) cases, popliteal artery with tibioperoneal bifurcation in 6 (12.76 %) cases, and popliteal artery with both SFA and tibioperoneal bifurcation in 4 (8.52 %) cases. The patency of the endarterectomy was determined as primary patency and primary assisted patency. The primary patency rates were 97.87 % at discharge and at 1 month and 95.74 %, 93.61 % and 89.36 at 6 months, 1 year and at 3 years respectively. 3 patients required balloon dilation of the endarterectomy site at 1 and 3 year and the primary assisted patency rates were 95.74 % at 1 year and at 3 years. Major amputation was done in one patient along with lumbar sympathectomy. In 1 patient, femoro-popliteal vein bypass was done on 12th post-operative day because of the haemorrhage from the arteriotomy site. The present study illustrates that endarterectomy of the popliteal artery should be considered a viable option to bypass techniques in selected patients with localized disease. Endarterectomy provides for revascularization without use of the long sephenous vein. It also spares the long sephenous vein for its use if a future bypass, either coronary or femoro-popliteal or tibial, is required. Furthermore, amputation may be avoided in a vast majority of patients with threatened limbs.