Endovascular femoropopliteal bypass: a cadaveric study.

OBJECTIVE: Patency rates of standard femoropopliteal bypass in infra-inguinal occlusive disease have yet to be matched by minimally invasive percutaneous procedures. We report a feasibility study of a less invasive endovascular femoropopliteal bypass technique. METHODS: (1) groin exposure of femoral artery, (2) guidewire passage and mechanical dilatation of superficial femoral artery (SFA), (3) expandable helical cutter endarterectomy of SFA, (4) transluminal placement of PTFE graft, (5) graft balloon dilatation to shape and set distal interface and (6) end-to-end anastomosis of proximal graft to femoral artery. Development and testing was undertaken in 48 limbs of 26 fresh human cadavers. Limbs with no demonstrable SFA disease were excluded. Seventeen limbs had mild, diffuse disease. Three limbs had a single, short, tight stenosis. Seventeen limbs had multiple, high grade stenotic lesions 12-40 cm long (mean 24 cm). Eleven limbs had occlusive lesions, 8-38 cm long (mean 24 cm). RESULTS: We successfully completed the procedure in 39 (81%) limbs. We failed to complete the procedure in nine limbs; four from failed guidewire passage, four from vessel avulsion, and one from graft deployment failure. Histology confirmed endarterectomy cleavage in the standard plane. Angiography and explants demonstrated a patent graft and popliteal artery, and smooth distal graft/arterial interface with no obvious defects in 24 (62%) cases. Defects included combinations of: contrast extravasation/reflux, graft malpositioned/incorrectly sized, distal graft fold, and distal intimal flap. CONCLUSION: Endovascular femoropopliteal bypass is feasible and warrants further studies for possible clinical application.

Endovascular femoropopliteal bypass: early human cadaver and animal studies.

We report herein a feasibility study of a minimally invasive endovascular femoropopliteal bypass procedure. The steps include the following: (1) a small groin incision to expose the femoral artery, (2) guidewire passage and mechanical dilatation of the diseased superficial femoral artery, (3) semiclosed endarterectomy of the superficial femoral artery using an expandable metal endarterectomy catheter that engages atheroma, (4) placement of a 6 mm thin-walled PTFE graft, (5) balloon dilatation of the graft to press the graft flat against the arterial wall, and (6) a standard end-to-end anastomosis of the proximal graft to the femoral artery. This technique was tested in 13 limbs from eight fresh (stored 1 to 5 days at 4 degrees C) human cadavers (seven females and one male). Five limbs had stenotic superficial femoral artery lesions, 1 to 15 cm (mean 7.6 cm). Four limbs had occlusive lesions, 9 to 38 cm long (mean 26.8 cm). Four limbs had no disease. We successfully completed the procedure in 10 of 13 limbs. Completion arteriography showed a widely patent graft and a popliteal artery with a smooth distal graft/arterial interface in 9 of 10 limbs; one had a distal graft fold due to a size mismatch. Histologic studies of the superficial femoral artery revealed intima, atheromatous plaque, and media. We failed to complete our procedure in three limbs: two because of inadequate instruments and one because of perforation of the artery. We also performed the same procedure unilaterally in six dogs, except that no endarterectomy was performed.(ABSTRACT TRUNCATED AT 250 WORDS)