The Mollring Cutter remote endarterectomy: preliminary experience with a new endovascular technique for treatment of occlusive superficial femoral artery disease.

Abstract

To evaluate the feasibility and efficacy of the Mollring Cutter remote endarterectomy (EA) technique in the treatment of occlusive superficial femoral artery (SFA) disease. A new device was developed to perform remote EA of occluded SFAs through a single groin incision. The technique initially uses a conventional ring stripper, which is exchanged for a double-ring cutter that transects the distal atheroma core. The entire core and cutter are removed simultaneously, and a Palmaz stent is implanted to secure the distal intimal flap. Twenty-six consecutive patients with disabling claudication or critical ischemia were treated for long segment occlusions (n = 23) and multiple stenoses (n = 3). Patients were evaluated on the intention-to-treat basis. Clinical and anatomic success was achieved in all 26 SFAs. Average length of the endarterectomized segments was 29.9 cm (range 23 to 41). Technical problems were encountered intraoperatively in four patients, including one who required a second incision at the distal SFA to retrieve a broken ring. Recovery was uneventful in all patients. At up to 6-month follow-up, one reocclusion has been seen at 5 months. Based on this early experience, remote EA with the Mollring Cutter appears to be feasible and effective method for treating occlusive SFA disease. Obviating the need for a second incision at knee level, this technique offers a less invasive approach that should facilitate postoperative recovery and earlier discharge.